COLONIC  THERAPY 


IN  THE 

TREATMENT  OF  DISEASE 


BY 

O.  BOTO  SCHELLBERG 


NEW  YORK 

American  Institute  of  Medicine,  Inc, 

1923 


126046 


Copyright,  1923,  by 

O.  BOTO  SCHELLBERG 


Press  of 

J.  J.  Little  & Ives  Company 


y/'z/l'f 

Jlfi 


<s  / *•  3 ^ 


This  Book  Is  Gratefully  Dedicated 
to 

Those  Men  and  Women  of  the  Medical  Profession 

Who,  with  inexhaustible  patience  and  good  will,  and  with 
no  thought  of  recompense  other  than  the  benefit  to  humanity, 
found  time,  notwithstanding  their  devotion  to  their  own  scien- 
tific pursuits,  to  help  me  in  solving  the  many  problems  that 
arose  in  the  development  of  the  technic  herein  described. 


126046 


Digitized  by  the  Internet  Archive 
in  2016  with  funding  from 
Duke  University  Libraries 


https://archive.org/details/colonictherapyin01sche 


<r 


CONTENTS 

CHAPTER  PAGE 

I  The  Evolution  of  the  Alimentary  Canal  . 17 

Darwin’s  law  of  divergence  linked  to  Os- 
born’s law  of  “adaptative  radiation” — Adapta- 
tion of  man  to  his  environment  largely  a 
matter  of  modification  of  his  digestive  appara- 
tus to  meet  dietary  requirements — Crile’s 
observations  upon  the  crudeness  of  certain 
natural  mechanisms — Comparative  intestinal 
anatomy  of  certain  Australian  animals — Most 
important  cecal  changes  noted  in  the  wombat, 
koala  and  Tasmanian  devil — Man’s  intellect 
has  enabled  him  to  alter  his  dietary  conditions 
— Present  day  methods  of  food  preparation 
have  a strong  influence  on  digestive  function 
—Cell  metabolism  is  regulated  by  a special- 
ized group  of  organs — All  forms  of  life  de- 
pendent upon  bacteria — Beneficent  and  harm- 
less bacteria  may  become  malignant  if  their 
host’s  vitality  is  lowered — Intestinal  foci  of  in- 
fection frequently  overlooked. 

II  Intestinal  Bacteria 33 

Bacterial  fecal  flora  of  infants — Changes  in 
fecal  flora  due  to  the  development  of  the  indi- 
vidual and  the  ingestion  of  a more  varied  diet 
— Growth  of  putrefactive  organisms  due  to 
fecal  stasis — Production  of  toxins  due  to  dis- 
turbance of  function — Cathartics  useless  un- 
less the  cause  of  the  infection  be  first  removed 
— Predominance  of  Bacillus  coli — Other  or- 
ganisms found  in  the  intestinal  tract. 

Ill  Anatomy  and  Physiology  of  the  Intestine  . 45 

Comparative  anatomy  of  the  digestive  tract 
— Subdivisions  of  the  intestinal  tube — The 

7 


8 


CONTENTS 


CHAPTER 

valvulae  conniventes,  villi  and  agminated  fol- 
licles— Anatomy  of  the  colon — Peristalsis — 
The  mechanics  of  digestion — Reverse  peristal- 
sis— Existence  of  colonic  sacculations  makes 
good  drainage  essential — Digestibility  of  vege- 
table fibers— of  milk — The  constituents  of  the 
feces — Intestinal  secretions — Special  func- 
tions of  the  cecum. 

IV  The  Relation  of  Colonic  Pathology  to  Sys- 
temic Infection 

Chemical  changes  induced  by  disease — The 
theory  of  focal  infection — The  endocrine 
glands — “Errors  of  metabolism” — Infective 
foci  not  always  located  in  the  head — Stokes 
on  causes  of  colitis — Abolition  of  colonic  stasis 
must  precede  any  form  of  therapy — Health 
and  proper  function  dependent  upon  elimina- 
tion of  toxic  products — Autonomy  of  the 
gastro-intestinal  tract — Purpose  of  colonic  ir- 
rigation the  establishment  of  thorough  drain- 
age— Inefficacy  of  catharsis — The  colon  a 
neglected  and  despised  organ,  but  capable  of 
“reformation” — Intestinal  interlining  adhe- 
sions— Case  on  pathology  of  the  colon — Di- 
verticula— Their  occurrence  in  the  obese — 
Symptoms  of  pathologic  lesions. 


V The  Futile  Enema 

Establishment  of  free  colonic  drainage  nec- 
essary to  health — Effects  of  intra-abdominal 
pressure— Futility  of  the  enema  as  usually  ad- 
ministered— Hot  solutions  ivholly  ineffective 
without  preliminary  emptying  of  the  colon — - 
Effect  of  method  of  irrigation  without  special 
apparatus — Proper  irrigative  treatment  does 
not  produce  shock,  but  stimulation — Consis- 
tent, continued  irrigation  only  is  effective — 
Roentgenologic  diagnoses  of  diseased  condi- 
tions that  have  been  effectually  relieved  by 
properly  applied  irrigation. 


CONTENTS 


9 


CHAPTER  PAGE 

VI  Technic  of  Colonic  Irrigation  ....  103 

Local  medication  most  effective  in  the  colon 
— Necessity  of  clearing  the  gut  before  apply- 
ing local  treatment — Description  of  cecum 
tube — Apparatus  for  irrigation — Formulas  for 
irrigating  solutions — Purpose  of  the  different 
solutions- — Control  of  intestinal  hemorrhage — 
Absorption  of  fluid — Coloptosis — Method  of 
relief — Peristalsis  as  an  aid  in  emptying  the 
impacted  cecum — Position  of  patient  for  irri- 
gation— Method  of  advancing  the  tube. 

VII  Special  Applications  of  Colonic  Irrigation  119 

Colonic  atony — Treatment  of  fecal  impac- 
tion following  milk  diet — Causal  organism  in 
arthritis — Method  of  irrigating  a spastic  colon 
—Bacterial  colonization — Irrigating  in  the 
presence  of  putrefactive  foci — Stimulating  ef- 
fect of  irrigation — Fecal  impaction  simulating 
malignancy — Irrigation  when  malignancy  is 
suspected — Dilatation  of  colonic  angulations 
and  flexures — Preparation  for  x-ray  observa- 
tion. 

VIII  Antiseptics  and  Bacterial  Implantations  . 137 

Colonic  “clean-up”  and  catharsis — Technic 
of  bacterial  implantation- — Relative  merits  of 
Bacillus  acidophilus  and  Bacillus  bulgaricus — 

Value  of  bacterial  implantations — Necessity 
for  thoroughly  cleansing  the  intestinal  canal 
previous  to  implantation — Condition  of  pa- 
tients after  bacterial  implantation — Bacterial 
cultures — Coincident  administration  of  ca- 
tharsis. 

IX  Fecal  Stasis  and  Its  Consequences  . . . 151 

Fecal  stasis  a more  accurate  definitive  than 
“constipation”- — Ptosis  primarily  due  to  lack 
of  drainage — Vermiform  muscles  of  the  human 
colon  comparable  to  the  muscles  of  serpents — 
Muscular  atony  results  from  fecal  stasis — Dis- 


10 


CONTENTS 


CHAPTER  PAGE 

tention  and  reverse  peristalsis,  more  remote  re- 
sults— Alimentary  substances  may  be  absorbed 
by  the  blood  stream,  generating  gases  later  on 
expelled  by  the  lungs — Color  and  odor  of  feces 
— Recurrence  after  operation  on  intestinal 
tract  often  due  to  fecal  stasis — Vomiting  as  a 
result  of  pathologic  conditions  in  the  colon — - 
Position  during  sleep  influences  fecal  stasis 
and  coloptosis — Psychoses  due  to  intestinal  in- 
fection— Enervation  of  the  colon — Origin  of 
pain — Mental  depression  as  a result  of  di- 
gestive imbalance — Vagotonia — Relief  of  men- 
tal symptoms  by  establishment  of  proper  co- 
lonic drainage. 

X The  Human  Machine 169 

The  “chronic  abdomen’’ — Hutchison’s  de- 
lineation— Adequate  colonic  drainage  a cure 
for  most  uncatalogued  abdominal  ills — Oper- 
ation often  avoided  by  abolishing  fecal  stasis 
and  establishing  a properly  balanced  fecal 
flora — Medicinal  treatment  unavailing  with- 
out previous  “cleaning  out”  — Abdominal 
asthenia — The  effect  of  corset  wearing — Alco- 
holic indulgence  vs.  muscular  atrophy — Inju- 
rious effects  of  a saccharide  diet — Campbell’s 
views — The  necessity  for  moderation  and  uni- 
formity in  eating — The  care  of  the  human 
machine. 


Bibliography 193 

Index 197 


ILLUSTRATIONS 


FIG.  FACING  PAG© 

1.  Fecal  Smear  (Stained  by  Gram’s  Method)  . . 36 

This  specimen  shows  a predominance  of 
staphylococci. 

2.  Fecal  Smear  (Stained  by  Gram’s  Method)  . . 38 

Mixed  flora,  with  noticeably  prominent  thread- 
form  saprophytic  organisms  of  unusual  length. 
Specimen  taken  from  a patient  suffering  from  a 
large  pocket  in  the  transverse  colon. 

3.  Fecal  Smear  (Stained  by  Gram’s  Method)  . . 40 

Abundant  gowth  of  streptococcus. 

4.  Fecal  Smear  (Stained  by  Gram’s  Method)  . . 42 

Marked  predominance  of  Bacillus  aerogenes 
capsulatus  among  mixed  flora. 

5.  Fecal  Smear  (Stained  by  Gram’s  Method)  . . 44 

Cultures  from  this  patient  showed  an  almost 
pure  strain  of  an  organism  of  saprophytic  origin. 

There  'was  noticeable  irregularity  in  taking  the 
stain.  This  patient  had  a mammoth  cecum,  with 
marked  hypotonia. 

6.  Section  op  Intestinal  Interlining  Adhesion  . 70 

This  was  removed  from  the  transverse  colon 
through  a rectal  tube.  Macroscopic  examination 
showed  about  120  c.c.  light  brown  feces,  contain- 
ing strips  of  smooth,  soft,  grayish  material,  vary- 
ing in  length  from  1 to  6 cm.,  about  2 cm.  in 
depth,  and  having  an  average  width  of  about  1 
cm.  Microscopically,  without  staining,  strips  of 
fibrin  enmeshing  red  blood-cells  and  desquamated 
epithelium  were  visible.  On  section,  irregular 
11 


12 


ILLUSTRATIONS 


PIQ.  FACING  PAGE 

strips  of  fibrin  were  seen,  with  necrotic  debris 
containing  red  blood-cells  and  desquamated  epi- 
thelium. 

7.  Membranous  Mass  Removed  from  a Diverticulum  72 

Showing  a heavy  growth  of  staphylococcus, 
from  a case  of  coloptosis  with  large  dilated 
cecum.  This  patient  had  suffered  for  ten  years 
from  dermatitis  herpetiformis  of  the  entire  body, 
all  evidences  of  which  disappeared  after  three 
months’  treatment  of  the  colon. 

8.  Intestinal  Interlining  Adhesion  ....  74 

Specimen,  which  shows  decomposition,  re- 
moved from  an  angulation  of  the  sigmoid,  fol- 
lowing clean-up  treatment  and  implantation  of 
Bacillus  acidophilus  and  Bacillus  bulgaricus. 
Intestinal  flora  represented  (in  order  of  predom- 
inance) are  staphylococcus,  streptococcus  and 
Bacillus  coli. 

9.  Membrane  and  Feces  from  a Large  Pocket  in 

tile  Transverse  Colon 76 

Removed  after  antiseptic  treatment  and  the 
application  of  ichthyol. 

10.  Specimen  from  the  Same  Case  as  Fig.  9 . 80 

Specimen  was  removed  following  the  fourth 
implantation  of  Bacillus  acidophilus  and  Bacillus 
bulgaricus.  Note  the  breaking  down  of  the  mem- 
brane. 

11.  Intestinal  Interlining  Adhesions  ....  82 

These  caused  a partial  constriction  in  the 
splenic  flexure  of  a patient  suffering  from  co- 
loptosis. This  specimen  was  removed,  following 
the  application  of  antiseptic  solutions  and  four 
implantations  of  Bacillus  acidophilus  and  Ba- 
cillus bulgaricus. 


ILLUSTRATIONS 


13 


FIG.  FACING  PAGE 

12.  Different  Sizes  of  Cecum  Tubes 108 

The  upper  instrument  is  called  the  large  cecum 
tube;  second,  the  large  colon  tube;  third  and 
fourth,  medium-sized  cecum  tubes;  fifth  and 
smallest,  the  tracer.  (Eighteen  years  of  experi- 
mentation were  required  to  perfect  the  shape  of 
this  point  so  that  it  could  be  readily  passed  into 
the  cecum,  and  its  production  was  only  possible 
through  the  untiring  assistance  of  Messrs.  George 
Tiemann  and  Company,  to  whom  I am  much  in- 
debted.) 

13.  Operating  Table  and  Irrigator,  Showing  the 

Three-Way  Valve 112 

When  the  treatment  is  concluded,  the  patient 
may  be  raised  into  the  sitting  position  while  still 
upon  the  table. 

14.  Roentgenoscopic  View  of  Colon,  Following 

Examination  and  Initial  Treatment  . . . 124 

The  figure  shows  the  faint  outline  of  a large 
fecal  impaction  in  the  cecum,  which  is  resting 
against  the  redundant  sigmoid.  In  the  middle 
third  of  the  transverse  colon  a faint  shadow  is 
visible.  As  the  colon  displays  no  sacculi,  it  is 
evident  that  the  impaction  of  feces  prevented  the 
complete  filling  by  the  barium  meal. 

15.  Same  Case  as  Fig.  14,  Showing  Normal  Tone 

and  Position  of  Colon  after  Six  Weeks’ 
Treatment 128 

Antiseptic  solutions  and  implantations  of  Ba- 
cillus acidophilus  and  Bacillus  hulgaricus  were 
employed.  Sigmoid  redundancy  is  entirely  re- 
duced; well  formed  colon  sacculi  indicate  restora- 
tion of  a normal  tonus.  A transient  sphincter  is 
distinctly  outlined,  and  the  traction  of  the  vermi- 
form muscles,  forcing  the  splenic  flexure  into  a 
moving  loop,  is  clearly  evident. 


14 


ILLUSTRATIONS 


FIG.  FACING  PAGE 

16.  Roentgenoscopic  View  of  Forty-six  Inches  of 

Rectal  Tube  in  the  Colon 130 

The  position  of  the  colon  here  shown  is  only- 
one  of  a great  number  which  may  be  encountered 
in  the  course  of  high  colonic  irrigation. 

17*  Colon  Filled  with  a Barium  Meal  ....  132 

This  shows  contraction  of  the  vermiform  mus- 
cles in  the  act  of  raising  the  colon  in  order  to 
expel  its  contents.  A faint  shadow  outlines  the 
path  of  the  cecum,  showing  it  in  the  act  of  rising 
as  the  picture  was  taken.  In  this  case,  previous 
palpation  clearly  indicated  that  the  cecum  lay 
very  low  in  the  right  iliac  fossa.  The  gas  forced 
out  by  the  entrance  of  the  roentgenographic  meal 
can  be  seen  in  the  sigmoid,  holding  back  the 
barium  meal. 

18.  Convincing  Evidence  of  the  Necessity  of 
Thoroughly  Cleaning  Out  the  Colon  before 
Roentgenographic  Examination  ....  140 

Many  abnormalities  can  be  made  out,  includ- 
ing exaggerated  sacculi,  angulations,  an  incom- 
petent ileocecal  valve,  and  a ptosed  sigmoid. 


19.  Mixed  Culture  of  Bacillus  Acidophilus  and 

Bacillus  Bulgaricus 142 

20.  Bacillus  Bulgaricus  in  Pure  Culture  . . . 144 

21.  Bacillus  Acidophilus  Cultured  in  Toast  Me- 

dium (Stained  by  Gram’s  Method)  ....  148 

22.  Fecal  Smear  (Stained  by  Gram’s  Method)  . . 156 


Made  after  ten  implantations  of  Bacillus 
acidophilus ; the  specimen  shows  a varied  flora, 
with  an  average  growth  of  the  implanted  organ- 
ism. Examination  of  the  first  specimen  taken 
from  this  patient  had  shown  a predominance  of 
Bacillus  coli  and  staphylococci,  -with  practically 
no  Bacillus  acidophilus. 


ILLUSTKATIONS 


15 


FIG.  FACING  PAGE 

23.  Fecal  Smear  (Stained  by  Gram’s  Method)  . . 160 

Made  three  months  after  completion  of  a 
course  of  treatment.  Exceptionally  abundant 
growth  of  Bacillus  acidophilus.  At  the  beginning 
of  the  treatment,  the  patient,  aged  sixty-five, 
showed  a fecal  flora  in  which  Bacillus  coli,  strep- 
tococci and  Bacillus  aerogenes  capsulatus  pre- 
dominated, very  few  Gram-positive  bacilli  being 
in  evidence. 


CHAPTER  I 


THE  EVOLUTION  OF  THE  ALIMENTARY  CANAL 

Darwin’s  law  of  divergence  linked  to  Osborn’s  law  of 
“adaptative  radiation” — Adaptation  of  man  to  his  environment 
largely  a matter  of  modification  of  his  digestive  apparatus  to 
meet  dietary  requirements — Crile’s  observations  upon  the 
crudeness  of  certain  natural  mechanisms — Comparative  intes- 
tinal anatomy  of  certain  Australian  animals — Most  important 
cecal  changes  noted  in  the  wombat,  koala  and  Tasmanian 
devil — Man’s  intellect  has  enabled  him  to  alter  his  dietary 
conditions — Present  day  methods  of  food  preparation  have 
a strong  influence  on  digestive  function — Cell  metabolism  is 
regulated  by  a specialized  group  of  organs — All  forms  of  life 
dependent  upon  bacteria — Beneficent  and  harmless  bacteria 
may  become  malignant  if  their  host’s  vitality  is  lowered — 
Intestinal  foci  of  infection  frequently  overlooked. 


COLONIC  THERAPY 


CHAPTER  I 

THE  EVOLUTION  OF  THE  ALIMENTARY  CANAL 

Darwin’s  law  of  divergence  linked  to  Osborn’s  law  of 
“adaptative  radiation” — Adaptation  of  man  to  his  environment 
largely  a matter  of  modification  of  his  digestive  apparatus  to 
meet  dietary  requirements — Crile’s  observations  upon  the 
crudeness  of  certain  natural  mechanisms — Comparative  intes- 
tinal anatomy  of  certain  Australian  animals — Most  important 
cecal  changes  noted  in  the  wombat,  koala  and  Tasmanian 
devil — Man’s  intellect  has  enabled  him  to  alter  his  dietary 
conditions — Present  day  methods  of  food  preparation  have 
a strong  influence  on  digestive  function — Cell  metabolism  is 
regulated  by  a specialized  group  of  organs — All  forms  of  life 
dependent  upon  bacteria — Beneficent  and  harmless  bacteria 
may  become  malignant  if  their  host’s  vitality  is  lowered — In- 
testinal foci  of  infection  frequently  overlooked. 


More  than  half  a century  ago  Darwin,  seeking 
to  interpret  in  the  light  of  the  current  morphology 
of  his  time  the  facts  that  he  had  demonstrated 
in  regard  to  variability  and  the  theory  of  natural 
selection,  said:  “We  must  look  at  every  compli- 

cated mechanism  and  instinct  as  the  summary  of 

a long  history  of  useful  contrivances,  much  like  a 

19 


COLONIC  THERAPY 


20 

work  of  art.”  1 Yet,  in  examining  the  works  of 
Darwin,  we  find  that  his  conclusions  give  little 
consideration  to  such  problems  as  functional  adap- 
tation and  the  correlation  of  parts.  It  remained 
for  a man  of  our  own  time  and  country  to  link 
the  law  of  divergence  which  Darwin  had  demon- 
strated, to  his  own  law  of  “adaptative  radiation,” 
thus  establishing  what  Russell  has  termed  “a 
brilliant  vindication  of  the  functional  point  of 
view.”  2 

“According  to  this  law,”  says  Henry  Fairfield 
Osborn,  “each  isolated  region,  if  large  and  suffi- 
ciently varied  in  its  topography,  soil,  climate,  and 
vegetation,  will  give  rise  to  a diversified  mam- 
malian fauna.  From  primitive  central  types, 
branches  will  spring  off  in  all  directions,  with  teeth 
and  prehensile  organs  modified  to  take  advantage 
of  every  possible  opportunity  of  securing  food, 
and  in  adaptation  of  the  body,  limbs  and  feet  to 
habitats  of  every  kind.  The  larger  the  region  and 
the  more  diverse  the  conditions,  the  greater  the 
variety  of  mammals  which  will  result.  The  most 
primitive  mammals  were  probably  insectivorous 
or  omnivorous  forms,  therefore  with  simple,  short- 
crowned  teeth,  of  slow-moving,  ambulatory,  ter- 
restrial or  arboreal  habit,  and  with  short  feet 
provided  with  claws.  ...  In  the  case  of  teeth, 
insectivorous  and  omnivorous  types  appear  to  be 
more  central  and  ancient  than  either  the  exclu- 


EVOLUTION  OF  ALIMENTARY  CANAL  21 

sively  carnivorous  or  herbivorous  types.  Thus, 
the  extremes  of  carnivorous  adaptation,  as  in  the 
case  of  the  cats;  of  omnivorous  adaptation,  as  in 
the  case  of  the  bears;  of  herbivorous  adaptation, 
as  in  the  case  of  the  horses;  or  myrmecophagous 
adaptation,  as  in  the  case  of  the  ant-eaters,  are  all 
secondary.”  3 

It  is  toward  the  end  of  this  secondary  stage  of 
adaptation  that  we  are  able  to  visualize  man  as  he 
emerges  from  among  his  fellow  creatures  and  be- 
comes differentiated  as  a separate  and  dominant 
genus.  The  history  of  man’s  emergence  has  been 
diligently  studied,  and  the  tale  of  it  frequently 
related,  but  the  variations  in  his  diet  and  the  modi- 
fications which  took  place  in  the  structure  of  his 
digestive  apparatus,  in  consequence  of  the  inges- 
tion of  the  materials  of  this  diet,  do  not  usually 
receive  the  consideration  that  their  importance  in 
the  plan  of  human  development  would  seem  to 
warrant.  It  is  by  no  means  unreasonable  to  sup- 
pose that  it  was  because  of  the  adaptability  of  his 
digestive  apparatus  that  man  was  able  to  rise  to 
his  position  of  superiority  over  the  other  animals. 
As  Crile  has  expressed  it; 

“From  colloidal  slime  to  man  is  a long  road,  the 
conception  of  which  taxes  our  imaginations  to  the 
utmost.  Indeed,  the  problems  of  the  missing  links 
are  not  so  difficult  as  is  the  origin  of  the  organs 
and  functions  which  man  has  acquired  as  products 


22 


COLONIC  THERAPY 


of  adaptation.  For  whether  we  look  upon  the 
component  parts  of  our  present  bodies  as  useful 
or  useless  mechanisms,  we  must  regard  them  as 
the  result  of  age-long  conflicts  between  environ- 
mental forces  and  organisms. 

“In  the  first  delight  of  finding  a rich  display  of 
beautiful  and  ingenious  mechanisms  for  the  preser- 
vation of  life  in  plants  and  animals,  we  are  prone 
to  overestimate  the  ‘marvelous  efficacy’  of  these 
contrivances,  and  to  ignore  the  presence  of  many 
imperfect  and  involved  mechanisms  which  make 
life  precarious  for  the  average  organism.  For  ex- 
ample, what  a vast  amount  of  superfluous  energy 
has  apparently  been  wasted  in  making  the  long- 
distance arrangement  for  fertilization  in  certain 
plants,  which  first  produce  flowers  by  which  to 
attract  insects  on  the  chance  that  they  may  brush 
against  the  pollen  and  carry  it  to  another  flower!” 
To  this  writer  it  seems  that  some  of  the  mechan- 
isms of  human  bodies  are  equally  crude:  “the 
twenty  feet  or  more  of  intestine  which  give  har- 
borage to  poisonous  gases  and  germs”;  or  perhaps 
those  structures  which,  serviceable  in  early  life, 
become  cumbersome  and  dangerous  if  they  survive 
in  adult  development,  like  the  thymus  gland  or 
faucial  tonsil.  “If  the  result  of  man’s  haphazard 
assemblage  of  organs  is  to  some  extent  adequate 
to  the  needs  of  his  present  environment,  it  is  be- 
cause during  the  age-long  process  of  evolution  all 


EVOLUTION  OF  ALIMENTARY  CANAL  23 

the  fatally  awkward  combinations  have  been  elimi- 
nated by  a struggle  so  keen  that  the  slightest  varia- 
tion in  the  length  of  a leaf,  the  strength  of  a limb  or 
the  color  of  an  egg,  has  given  the  victory  to  a rival 
species.  Throughout  this  struggle,  survival  has 
depended  on  one  of  two  conditions:  the  possession 
of  extreme  stability,  the  quality  of  withstanding  all 
destructive  forces  in  the  environment;  or,  the  pos- 
session of  lability,  the  quality  of  adaptability  to 
various  conditions  in  the  environment.  Rocks  are 
an  example  of  the  first  condition;  man  and  the 
higher  animals  of  the  second.”  4 

Yet,  comparison  of  human  physical  develop- 
ment with  that  of  other  animals  might  lead  us  to 
conclusions  somewhat  different  from  those  to  which 
Crile’s  investigations  and  reflections  have  con- 
veyed him.  Some  years  ago,  Stapley  and  Mac- 
Kenzie,5  two — at  that  time — relatively  obscure 
physicians  of  Australia,  made  a study  of  certain 
animals  native  to  the  Australian  continent,  with 
a view  to  determining  some  of  the  developmental 
changes  which  had  taken  place  in  the  cecums  and 
vermiform  appendices  of  these  creatures.  Since 
Australia  is — paleontologically  speaking — much 
younger  and  newer  than  any  other  part  of  our 
world,  a study  of  the  animal  forms  which  are  still 
in  existence  upon  that  continent  enables  one  to  ob- 
serve transitional  epochs  of  development  which 
would  be  impossible  under  any  other  conditions. 


24 


COLONIC  THERAPY 


These  authors  confined  their  ipvestigations  to  the 
monotremes — the  lowest  existing  order  of  mam- 
mals, oviparous  and  having  only  rudimentary 
mammary  glands — and  the  marsupials — a genus 
distinguished  by  being  provided  with  a marsupium, 
or  pouch,  for  the  conveyance  and  nourishment  of 
the  young. 

The  marsupials  presented  variations  in  bowel 
structure,  ranging  all  the  way  from  enormous 
cecal  development  to  the  entire  obliteration  of  that 
organ.  The  most  important  cecal  changes  were 
observed  in  the  wombat,  the  koala — the  native 
Australian  bear  which  does  not  hibernate — and  the 
Tasmanian  devil.  The  authors  preferred  not  to 
consider  a comparison  of  the  cecum  of  the  kanga- 
roo, which  is  the  best  known  representative  of  the 
marsupials,  with  that  of  others  of  the  same  genus 
having  simple  stomachs,  as  the  stomach  of  the 
kangaroo  is  sacculated  to  such  an  extent  that  it 
resembles  the  cecum  of  a horse,  and  it  is  their  belief 
that  the  forms  of  both  stomach  and  cecum  are 
largely  dominated  by  the  sphincteration  of  which 
this  sacculation  is  the  result. 

The  wombat  possesses  a true  vermiform  appen- 
dix of  a structure  similar  to  that  of  man’s;  the 
koala  shows  enormous  cecal  development,  but  he 
has  no  appendix;  the  Tasmanian  devil  has  neither 
cecum  nor  vermiform  appendix;  the  stomach  of 
the  koala  is  like  that  of  the  wombat,  while  “the 


EVOLUTION"  OF  ALIMENTARY  CANAL  25 

cecum  of  the  wombat  and  that  of  man  are  alike  in 
their  architecture,”  each  showing  sacculations  and 
muscle  bands  terminating  in  the  appendix.  The 
wombat,  unlike  the  koala,  “does  not  live  in  trees; 
it  enjoys  life  in  a hole  in  the  ground.”  It  is  very 
fond  of  fern  root — a diet  said  to  have  been  com- 
monly used  by  the  Maoris  of  New  Zealand — but 
it  eats  other  things  as  well,  while  the  koala  pos- 
sesses no  adaptability  as  to  diet.  “He  must  have 
forest  gum  leaves  of  his  own  selection.  They  are 
essential  to  his  life.  Upon  this  highly  selected  diet 
the  koala  has  attained  a cecum  of  enormous  de- 
velopment, also  a large  colon,  guarded  toward  the 
outlet  by  a long  sphincteration.  This  wonderful 
cecum  and  colon  are  doubtless  organs  working  at 
great  economy,  extracting  from  gum  leaves  that 
pabulum  with  which  to  build  up  the  complex  tis- 
sues of  the  native  bear.  The  cecum  shows  no 
evidence  of  reduction  in  size  from  a larger  type; 
on  the  contrary,  it  possesses  longitudinal  bands  of 
mucous  membrane  which  readily  allow  of  greater 
bowel  distention.”  It  is  the  belief  of  the  authors 
that  a true  vermiform  appendix  cannot  come  into 
existence  without  longitudinal  muscle  bands  on 
the  cecum,  extending  as  far  as  the  cecal  apex  or 
beyond  it.  Investigation  of  the  digestive  appara- 
tus of  the  Tasmanian  devil  showed  that  “this  fierce 
marsupial  lives  entirely  on  flesh  and  fish.  Sim- 
plicity dominates  the  form  of  its  digestive  tract, 


26 


COLONIC  THERAPY 


no  differentiation  of  large  from  small  gut  showing. 
Its  digestive  apparatus  is  a simple  tube  with  a 
simple  stomach,  the  tube  being  practically  without 
sphincteration.  . . . 

“The  wombat,  with  its  vermiform  appendix  and 
its  varied  diet,  possesses  the  most  valuable  asset  a 
species  can  acquire;  he  shares  that  asset  with  man 
- — adaptability.  The  wombat  is  stronger  than 

either  the  koala  or  Tasmanian  devil — highly  spe- 
cialized animals.  The  wombat  is  a happy  animal. 
The  Tasmanian  devil  is  as  surly  as  a bear,  and  as 
fierce  as  its  name  indicates.  The  koala  is  only  fit 
for  a poetic  life  in  a pure  gum  forest — the  battle 
of  life  has  sounded  on  him  the  doom  of  early 
extinction. 

“These  three  marsupials  show  the  whole  history 
of  the  cecum:  The  koala  with  its  great  develop- 

ment of  cecum,  the  Tasmanian  devil  with  its  cecum 
atrophied  out  of  existence;  the  wombat  with  the 
hall-mark  of  adaptability,  an  atrophied  cecum, 
carrying  a true  vermiform  appendix.  Whether 
or  not  a receding  cecum  carrying  a true  vermiform 
appendix  marks  the  highest  in  bowel  development 
depends  entirely  upon  what  is  regarded  as  the 
highest  development.  The  cecum  and  vermiform 
appendix  of  the  wombat  represent  a development 
midway  between  a supposed  cecum  which  camiot 
be  found  in  the  Tasmanian  devil,  and  the  large 
cecum  of  the  koala.  The  vermiform  appendix 


EVOLUTION  OF  ALIMENTARY  CANAL  27 

represents  possible  and  probable  development 
in  two  directions — one  toward  a larger  cecum 
through  coarse  food — the  other  toward  annihila- 
tion of  the  cecum  through  soft  concentrated  food. 
By  this  central  position  bordering  the  confines  of 
two  extreme  specializations,  the  great  boon  of 
adaptability  is  conferred.  This  wonderful  adapt- 
ability has  doubtless  many  times  over  compensated 
all  the  suffering  and  loss  by  death  brought  about 
by  diseases  occurring  in  the  appendix.  For  these 
diseases,  an  evolutionary  study  offers  only  sugges- 
tions of  prevention  by  a return  to  a simpler  and 
coarser  diet  than  now  prevails.” 

In  a later  communication  (1923),  MacKenzie 
again  calls  attention  to  the  relation  existing  be- 
tween the  development  of  the  large  intestine  in 
these  marsupials  and  that  which  has  taken  place 
in  the  human  race.  “The  human  colon,”  he  tells 
us,  “consists  of  two  divisions  only  : (1)  From  the 
ileo-cecal  region  to  the  pyloric  region  where  we 
have  a direct  vagal  coimection,  is  right,  proximal 
or  mesenteric  colon.  This  includes  cecum  and 
appendix,  ascending  colon  and  hepatic  flexure.  It 
is  the  new  or  ‘experimental’  colon.  (2)  From  the 
pyloric  region  to  the  mid-sacrum  in  the  pelvis  is 
left,  distal  or  mesocolic  colon.  This  is  the  old  or 
primitive  colon  and  includes  the  portions  known  in 
man  as  transverse  colon,  splenic  flexure,  descend- 
ing colon,  iliac  colon  and  pelvic  colon.” 


28 


COLONIC  THERAPY 


We  have  been  told  that  “the  wombat” — with  his 
nicely  adjusted  digestive  apparatus — “is  a happy 
animal.”  But  those  who  are  concerned  with  the 
ills  to  which  man’s  equally  well  adapted  digestive 
apparatus  is  so  frequently  subject  will  bear  abun- 
dant testimony  that  man — digestively  speaking  at 
any  rate— is  frequently  very  far  from  being  a 
“happy  animal.”  To  account  for  this,  it  is  neces- 
sary to  consider,  not  alone  the  advance  of  man 
along  the  physical  lines  marked  out  for  him  by 
climatic  conditions  and  alimentary  supplies,  but 
also  the  development  of  his  brain  which  has 
enabled  him  to  modify  his  environment  and  to 
alter  his  dietary  conditions,  often  in  ways  that  ex- 
perience has  proved  to  be  distinctly  detrimental 
to  his  animal  existence.  His  natural  locomotive 
apparatus,  for  instance,  has  been  enormously  sup- 
plemented, not  only  on  land  and  sea,  but  in  the 
air  and  beneath  both  earth  and  water,  so  that  he 
must  now  be  urged  to  use  his  legs  to  preserve  his 
physical  fitness.  His  fields  of  special  sense  have 
been  immeasurably  extended;  audition  has  been 
augmented  by  the  telegraph,  the  telephone  and 
their  latest  developments,  wireless  and  radio;  the 
telescope  and  microscope  have  widened  man’s 
range  of  vision;  and  photography — especially  in 
its  application  to  roentgenography  and  cinema- 
tography— has  levied  a tax  upon  his  powers  of 


EVOLUTION  OF  ALIMENTARY  CANAL  29 

sight,  for  which  all  the  lens-maker’s  adroitness 
cannot  compensate. 

In  the  same  manner,  the  perfection  of  culinary 
art,  the  endless  improvements  in  the  machinery  for 
milling,  and  the  knowledge  of  the  preparation  of 
meat  for  human  consumption,  have  brought  the 
materials  of  everyday  diet  to  such  a state  of  refine- 
ment that  our  alimentary  tracts  no  longer  receive 
the  necessary  amount  of  exercise,  and  our  organs 
of  excretion — like  those  of  the  soon-to-be-extinct 
koala  bear  of  Australia — are  beginning  to  display 
a disability  to  perform  the  functions  for  which 
they  were  designed. 

The  dangers  of  such  a situation  are  fully  ap- 
preciated by  workers  in  medicine  and  its  allied 
sciences.  Careful  studies  are  continually  being 
made  of  man’s  present  physical  equipment,  as  well 
as  of  its  source,  its  development  and  its  differentia- 
tion. The  trail  has  been  followed  back  until  it 
touches  the  “colloidal  slime,”  the  primitive  proto- 
plasm of  the  single  cell. 

Tracing  the  individual  back  to  his  beginning, 
studying  his  ontogenetic  career,  his  origin,  too,  is 
found  to  be  unicellular — the  single  cell  impreg- 
nated within  the  mother’s  womb.  His  phyloge- 
netic career  is  thus  duplicated  in  miniature.  At 
birth  the  bag  of  waters  ruptures  and  the  new-born 
child  struggles  to  exist  as  a land  animal,  following 


30 


COLONIC  THERAPY 


the  urge  handed  down  to  him  by  his  forebears 
through  the  ages. 

His  nutritional  problems  are  largely  a chemical 
give  and  take,  accomplished  through  fermental 
activity  down  to  the  single  cell  of  a group,  organ 
or  system.  Each  cell,  each  organ,  each  system  is 
an  intimate  and  closely  correlated  part  of  the 
whole,  incapable  of  independent  functional  activ- 
ity or  existence.  Each  cell  owes  its  existence  to 
a parent  cell,  and  the  metabolism  of  all  cells  ap- 
pears to  be  regulated  by  a specialized  group  of 
organs.  Disturbances  in  the  regulators  of  metab- 
olism lead  to  underdevelopment  or  overdevelop- 
ment in  cell  growth  and  cell  function.  These 
conditions  are  frequently  observable  in  the  indi- 
vidual’s general  physical  make-up,  manifested  by 
local  or  general  underdevelopment  or  overdevelop- 
ment, as  the  case  may  be. 

Animal  life  is  dependent  upon  vegetable  life, 
and  both  forms  of  life  would  cease  to  exist  if  all 
bacterial  life  were  destroyed.  Microorganisms  are 
vital  to  existence.  In  our  internal  chemistry,  they 
are  helpful  under  normal  conditions,  often  harmful 
when  resistance  is  lowered,  or  a surface  abraded. 
For  example,  the  pneumococcus  and  the  colon 
bacillus,  commonly  benign,  may  under  suitable 
conditions  cause  death  quite  as  certainly  as  the 
streptococcus. 

In  many  situations,  bacteria  appear  to  have 


EVOLUTION  OF  ALIMENTARY  CANAL  31 

about  them  a field  or  zone  of  ferment-like  activity 
— they  split  up  dead  tissues  into  simpler  chemical 
entities,  suitable  for  plant  nutrition,  without  actual 
contact  or  change.  They  may  be  likened  to  mobile 
enzymes;  harmless  to  their  host  as  long  as  the 
tissues  of  the  host  are  normal,  when  they  may  act 
as  helpful  scavengers.  But  let  the  resistance  of  the 
host  once  be  lowered  through  the  operation  of  the 
deterrent  factors  of  modern  civilization,  then  the 
once  harmless  bacteria  are  prone  to  invade,  and 
possibly  destroy  him. 

Even  with  the  ultramicroscope  and  our  highly 
specialized  modern  laboratory  procedures,  many 
bacterial  species  still  remain  unidentified.  Great 
numbers  of  focal  infections  still  escape  recogni- 
tion, though  their  toxic  effects  may  lead  to  such 
general  or  local  pathologic  conditions  as  defects 
of  vision  or  of  hearing,  arrest  of  mental  develop- 
ment, involvement  of  joints,  general  physical  over- 
development or  underdevelopment,  etc. 

In  my  experience,  the  alimentary  canal  is  the 
region  of  infection  most  frequently  overlooked; 
and  the  establishment  of  proper  colonic  drainage 
and  the  clearing  of  pathogenic  bacteria  from  the 
bowel  have  accomplished  astonishing  results,  such 
as  the  cure  of  epilepsy,  mental  hebetude,  arrested 
mental  and  physical  development,  diseased  joints, 
pendulous  abdomens,  ptosis  of  abdominal  and  pel- 
vic organs,  and  metabolic  disorders  generally. 


32 


COLONIC  THERAPY 


In  our  public  schools  we  examine  the  children 
for  various  infectious  diseases,  focal  infections, 
hypertrophied  tonsils,  adenoids,  caries  of  the  teeth, 
defective  eyesight,  hearing,  etc.,  but  we  completely 
ignore  their  alimentary  canals.  No  doubt  many 
a child  has  been  classed  as  mentally  abnormal  or 
“nervous,”  when  in  reality  he  was  simply  chroni- 
cally toxic  from  infection  in  the  alimentary  canal, 
and  needed  only  proper  treatment  to  restore  him 
to  health. 


CHAPTER  II 


INTESTINAL  BACTERIA 

Bacterial  fecal  flora  of  infants — Changes  in  fecal  flora  due 
to  the  development  of  the  individual  and  the  ingestion  of  a 
more  varied  diet — Growth  of  putrefactive  organisms  due  to 
fecal  stasis — Production  of  toxins  due  to  disturbance  of  func- 
tion— Cathartics  useless  unless  the  cause  of  the  infection  be 
first  removed — Predominance  of  Bacillus  coli — Other  organ- 
isms found  in  the  intestinal  tract. 


CHAPTER  II 


INTESTINAL  BACTERIA 

Bacterial  fecal  flora  of  infants — Changes  in  fecal  flora  due 
to  the  development  of  the  individual  and  the  ingestion  of  a 
more  varied  diet — Growth  of  putrefactive  organisms  due  to 
fecal  stasis — Production  of  toxins  due  to  disturbance  of  func- 
tion— Cathartics  useless  unless  the  cause  of  the  infection  be 
first  removed — Predominance  of  Bacillus  coli — Other  organ- 
isms found  in  the  intestinal  tract. 


At  birth,  the  meconium,  or  fetal  intestinal  con- 
tent, is  practically  sterile.  It  is  not  until  the 
greater  part  of  a day  has  elapsed  that  bacteria 
begin  to  appear  in  the  infant’s  alimentary  canal. 
The  conditions  surrounding  the  new-born  child  are 
largely  influential  in  determining  the  number  and 
variety  of  the  organisms  which,  from  that  time  on, 
gain  access  to  the  digestive  tract,  by  way  either  of 
mouth  or  anus.  If  the  weather  is  warm,  or  the 
environment  of  the  infant  is  unclean,  there  will,  of 
course,  be  a more  luxuriant  growth  than  when 
opposite  conditions  prevail. 

After  lactation  has  been  established  and  the  in- 
testinal content  of  the  new  arrival  is  permeated 

with  milk,  the  number  of  bacteria  in  the  digestive 

35 


36 


COLONIC  THERAPY 


canal  quickly  increases.  About  the  third  day  after 
birth,  Bacillus  bifidus — an  obligate  anaerobe,  fer- 
mentative in  character — can  be  detected.  This 
bacillus  acts  upon  the  lactose  and  other  sugars, 
forming  acid  in  considerable  quantities,  but  does 
not  give  rise  to  gas.  Bacillus  coli  is  early  found 
at  the  ileocecal  valve  and  in  the  cecum,  as  well  as 
in  the  colon.  It  is  noticeable  that  the  intestines  of 
artificially  fed  infants  produce  a far  greater  va- 
riety of  flora  than  those  of  infants  who  are  nour- 
ished by  the  natural  method. 

Extensive  studies  on  the  fecal  flora  of  infants 
have  been  made  at  Johns  Hopkins  Hospital. 
Smears  (stained  by  Ford,  Blackfan,  and  Batch- 
elor) from  the  evacuations  of  children  revealed 
six  different  types  of  organisms:  small  bacilli  both 
Gram-positive  and  Gram-negative,  Gram-positive 
micrococci,  streptococci  and  yeast-cells,  large 
Gram-positive  bacilli  and  spores  of  various  sizes 
and  shapes.  These  investigators  examined  the  de- 
jecta of  ten  breast-fed  babies  and  of  eighteen  arti- 
ficially fed  children,  varying  in  ages  from  one  to 
ten  years.  These  latter  were  fed  on  a mixed  diet, 
on  cow’s  milk,  raw  or  boiled,  on  buttermilk,  or  on 
protein  milk.  Except  in  rare  instances,  the  Gram- 
negative bacilli  were  the  most  abundant;  Gram- 
positive micrococci  and  streptococci  were  found  in 
six  of  the  ten  breast-fed  babies,  and  in  ten  of  the 
eighteen  artificially  fed  children.  Yeasts  were  ob- 


Fig.  1. — Fecal  smear  (stained  by  Gram's  method);  this  specimen 
shows  a predominance  of  staphylococci. 


INTESTINAL  BACTERIA 


37 


tained  in  six  of  these  eighteen  children,  two  of  the 
children  being  on  a diet  of  buttermilk  which  on 
culture  proved  to  contain  yeasts  in  great  numbers. 
In  three  other  cases,  milk  was  the  chief  article  of 
diet  and  in  one  instance  the  child  was  being  nour- 
ished on  protein  milk.  In  one  case,  the  stool  of 
a six  weeks’  baby  suffering  from  pyloric  stenosis 
and  fed  on  breast  milk,  was  also  full  of  yeasts.  In 
the  dejecta  of  the  breast-fed  children,  aerobic 
spore-bearing  bacteria  were  obtained  in  all  but  one 
case.  They  were  present  in  considerable  variety 
in  the  original  smears,  even  in  the  youngest  nurs- 
lings, evidently  finding  their  way  into  the  alimen- 
tary canal  of  the  child  as  soon  as  it  begins  to 
swallow.  It  is  the  opinion  of  these  authors  that 
the  presence  of  aerobic  spore-bearing  bacteria, 
Gram-positive  in  character,  in  the  dejecta  of  chil- 
dren, is  to  be  attributed  to  “their  mechanical  intro- 
duction with  the  richly  infected  food.”  This  was 
particularly  striking  in  the  cases  of  children  fed 
on  protein  milk  and  buttermilk.6 

When  the  individual  reaches  maturity,  the  bac- 
terial flora  of  the  large  intestine  will  for  the  most 
part  be  aerobic,  liquefying  bacilli — both  of  the  spo- 
riferous  and  of  the  nonsporiferous  types — together 
with  a limited  number  of  anaerobic  bacteria.  The 
presence  of  these  organisms  is,  of  course,  perfectly 
normal  when  they  remain  in  their  proper  location, 
but  it  is  important  to  realize — to  quote  the  expres- 


38 


COLONIC  THERAPY 


sion  of  Kendall 7 — that  “the  normal  intestinal  or- 
ganisms are  ‘opportunists,’  potentially  capable  of 
becoming  invasive  whenever  the  barriers  which 
ordinarily  suffice  to  limit  their  development  to  the 
lumen  of  the  alimentary  canal  become  impaired, 
giving  rise  to  endogenous  infections.” 

We  must  remember,  also,  that  the  intestine  is 
constantly  invaded  by  foreign  organisms  from  the 
world  outside,  and  it  is  their  presence  which  pro- 
duces changes  in  what  are  considered  the  normal 
intestinal  bacteria  and  modifies  their  activities. 
“Normal  intestinal  organisms,  or  types  indistin- 
guishable from  them  by  the  ordinary  methods  of 
study,  may  multiply  with  abnormal  luxuriance 
through  unusual  conditions,  extend  their  habitat, 
and  crowd  out  some  existing  organism,  eventually 
leading  to  abnormal  activities  in  the  alimentary 
canal  which  may  be  detrimental  to  the  host.” 
Thus  we  see  that  from  infancy  to  old  age  the  in- 
testine is  a battle-ground  wherein  a never-ceasing 
struggle  goes  on  between  the  native  population 
and  the  foreign  invader.  Moreover,  it  is  evident 
that  the  condition  of  the  flora  of  the  intestine  is 
one  of  the  most  important  factors  that  influence 
health,  even  determining  the  duration  of  life  itself. 

The  lactic  acid  fermentative  processes  should  be 
always  in  control,  but  if,  through  faulty  diet,  care- 
lessness, or  impure  food  supply,  the  butyric  acid 
ferments  and  putrefactive  organisms  become  pre- 


- 


Fig.  2. — Fecal  smear  (stained  by  Gram’s  method);  mixed  flora,  with 
noticeably  prominent  thread-form  saprophytic  organisms  of  unusual 
length.  Specimen  taken  from  a patient  suffering  from  a large 
pocket  in  the  transverse  colon. 


INTESTINAL  BACTERIA 


39 


dominant,  good  health  may  be  replaced  by  sickness 
and  disease.  As  a child  develops,  the  difficulty  of 
keeping  the  proper  balance  between  the  good  lactic 
acid  fermentative  processes  and  the  evil  putrefac- 
tive ones  becomes  greater.  With  the  coming  of 
teeth,  we  have  more  difficulty  in  keeping  the  oral 
cavity  properly  cleansed,  because  of  the  addition 
to  the  diet  of  meat,  eggs,  unmodified  milk,  and 
other  foods  which  cause  still  more  putrefactive 
activity  in  the  intestine. 

“The  alimentary  canal,  from  the  viewpoint  of 
bacteriology,  is  a most  efficient  incubator  and  cul- 
tural medium  combined,  in  which  bacterial  growth 
exceeds  in  both  intensity  and  complexity  that  of 
any  known  medium.  The  range  of  reaction  and 
composition  of  nutritive  substances  at  different 
levels  of  the  intestinal  tract  is  such  that  theoreti- 
cally a great  variety  of  bacteria  capable  of  de- 
veloping at  body  temperature  may  find  conditions 
favorable  for  their  growth  there.  The  prominent 
types  of  bacteria  that  appear  in  the  intestinal  flora 
of  a normal  person  are  fairly  constant  in  their 
occurrence,  but  there  may  be  well  marked  seasonal 
and  even  annual  variations  in  the  relative  propor- 
tions of  the  individual  groups  of  organisms  that 
comprise  the  flora.  This  suggests  that  the  normal 
bacterial  flora  is  acclimatized  to  the  intestinal  en- 
vironmental conditions  of  temperature,  reaction 
and  composition  of  food,  and  of  intestinal  secre- 


40 


COLONIC  THERAPY 


tions  at  different  levels.  It  also  indicates  that  the 
activities  of  the  organisms  that  comprise  the  nor- 
mal intestinal  flora  are  not  in  active  opposition  to 
those  of  the  host.  . . . The  bacteria  of  the  intes- 
tinal flora  change  along  rather  definite  lines  from 
infancy  to  adult  life,  as  the  diet  of  the  host  changes 
from  the  monotonous  pabulum  of  infancy  to  the 
varied  regimen  of  the  adult.  The  organisms  para- 
sitic upon  the  skin  and  other  surfaces  of  the  body 
do  not  exhibit  this  change  in  type,  and  it  is  reason- 
able to  attribute  the  relative  stability  of  the  skin 
flora  to  the  relative  constancy  of  the  environmental 
conditions  there,  while  the  succession  of  types  of 
intestinal  bacteria  from  infancy  to  adult  life  is 
rather  definitely  associated  with  corresponding 
changes  in  the  diet  of  the  host.”  7 

However,  in  the  extensive  growth  of  putrefac- 
tive organisms,  the  diet  is  a secondary  factor.  It 
is  the  retarded  movement  of  the  food  that  gives 
this  flora  opportunity  to  grow  within  the  alimen- 
tary canal,  and  to  attack  the  proteins.  The  ab- 
sorption of  an  increased  amount  of  toxin  then 
follows,  which  in  turn  affects  the  secretory  organs 
and  glands. 

When  there  is  no  lesion  in  the  alimentary  canal, 
a certain  amount  of  putrefactive  material  passing 
through  it  may  not  produce  any  active  symptoms. 
The  glandular  secretions  remain  normal,  and  the 
intestinal  waves  are  strong  enough  to  keep  the 


Fig.  3. — Abundant  growth  of  streptococcus  in  a fecal  smear  stained 
by  Grain’s  method. 


INTESTINAL  BACTERIA 


41 


fecal  current  moving.  This  active  current  is  a 
great  factor  in  health,  because  the  normal  flow 
of  the  fecal  currents  has  a strong  tendency  to 
prevent  the  colonization  of  putrefactive  microor- 
ganisms on  the  intestinal  wall.  It  is  only  when 
there  is  an  anatomic  defect  in  the  wall  of  the 
intestine,  which  results  in  the  production  of  toxins, 
or  when  there  is  a retardation  of  the  feces,  that 
bacteria  have  an  opportunity  to  colonize.  This 
may  take  place  even  when  the  intestinal  flora  is 
very  simple,  for  a large  colony  of  Bacillus  coli, 
in  conjunction  with  an  obstructed  fecal  current, 
is  capable  of  giving  rise  to  marked  systemic  dis- 
turbances. 

While  bacterial  organisms  enter  the  body  by 
many  routes,  the  most  frequent  avenue  of  infec- 
tion is  by  way  of  the  alimentary  canal.  Like- 
wise, the  greatest  part  of  the  elimination  of  the 
waste  or  toxic  material  which  is  constantly  going 
on  in  the  organism  is  by  way  of  the  intestine. 
Therefore,  so  long  as  the  excretory  organs  are  in 
good  working  order,  deleterious  bacteria  are  sys- 
tematically neutralized,  or  destroyed  and  elimi- 
nated. It  is  only  when  there  is  some  disturbance 
of  function  that  a change  in  the  physiologic  chem- 
istry of  the  digestive  tract  can  take  place,  with 
the  resultant  production  of  toxins.  These  toxins 
are  formed  by  the  action  of  bacteria  upon  meat 
fibers  and  other  protein  material  which  have  been 


42 


COLONIC  THEEAPY 


arrested  in  their  passage  through  the  intestine. 
Intestinal  stasis  from  whatever  cause — entero- 
ptosis,  pockets,  constrictions — is  always  one  of  the 
basic  causes  of  such  a putrefactive  process.  It 
has  been  pointed  out  by  some  recent  F rench 
writers  8 that  in  simple  constipation  where  the  ma- 
terial accumulates  in  the  descending  bowel,  there 
is  often  little  appreciable  effect  upon  the  subject’s 
general  health,  many  persons  seeming  to  support 
this  type  of  intestinal  stasis  without  trouble.  The 
difference  seems  to  be  in  the  point  of  arrest  of 
the  bowel  content.  While  in  left-sided  constipa- 
tion the  material  is  dry  and  bacterial  life  less  ac- 
tive, in  the  right  colon  we  have  a more  or  less 
liquid  condition,  because  moisture  is  constantly 
being  added  from  the  small  intestine;  this  keeps 
up  an  active  focus  of  infection,  resulting  in  gen- 
eral systemic  intoxication. 

If  alterations  occur  in  the  mucous  lining  of  the 
intestine,  the  character  of  the  excretion  will  be 
greatly  modified,  showing  a preponderance  of  pro- 
teolytic organisms,  which  inhibit  the  fermentative 
bacteria,  so  that  the  feces  becomes  putrid,  or  fetid, 
and  alkaline  in  reaction,  the  iodophilic  bacteria  al- 
most disappear,  and  the  volatile  fatty  acids  are 
greatly  reduced.  Under  these  conditions,  all  the 
digestive  products — proteins,  fats  and  carbohy- 
drates— contribute  material  for  the  generation  of 
toxins  which  are  capable  of  markedly  lowering 


Fig.  4.  Marked  predominance  of  Bacillus  aerogenes  caps u kit  us 
among  mixed  flora,  in  fecal  smear  (stained  by  Gram’s  method). 


INTESTINAL  BACTERIA 


43 


general  vitality.  The  effect  of  these  ptomaines 
upon  the  nervous  system  is  usually  evidenced  by 
the  asthenia  and  nervous  depression  which  these 
patients  so  often  exhibit.  Symptoms  of  pathologic 
colonic  conditions  will  appear  in  the  upper  part 
of  the  alimentary  tract;  foul  breath  and  coated 
tongue,  coupled  with  loss  of  appetite  and  gastric 
disturbance,  are  quickly  followed  by  loss  of  weight, 
often  very  severe.  On  palpation,  the  area  of 
tenderness  can  be  readily  established,  and  the  dis- 
tention will  sometimes  be  so  marked  as  to  suggest 
a malignant  growth. 

In  discussing  mucous  colitis,  Stauffer9  empha- 
sizes as  its  two  chief  causes  infection  and  incom- 
plete elimination.  While  he  is  particularly  inter- 
ested in  the  relation  he  has  observed  between  an 
infected  lower  bowel  and  mucous  colitis  with  ap- 
pendicitis, he  remarks  that  under  any  circum- 
stances, “no  amount  of  dietetic  or  local  medication 
will  have  any  value  until  the  infection  is  located 
and  removed.  Cathartics  add  insult  to  injury,  and 
are  mentioned  only  to  be  condemned.”  To  elimi- 
nate the  toxin-producing  mechanism,  we  must  first 
remove  the  material  from  which  the  toxins  are  be- 
ing generated,  and  thereafter  so  change  the  chem- 
ical conditions  as  to  restore  the  normal  balance. 

Only  a small  part  of  the  excreted  bacteria  can 
be  found  alive  in  the  feces  (one  per  cent  accord- 
ing to  Strassburger) . This  is  the  reason  that  we 


44 


COLONIC  THEKAPY 


often  cannot  grow  in  media,  organisms  which  we 
recognize  in  stained  fecal  smears.  The  best  way 
to  obtain  a specimen  for  bacterial  examination  is 
to  pass  a rectal  tube  to  the  point  of  infection  of 
the  colon.  The  bacteria  obtained  from  the  cecum 
develop  the  greatest  virulence  under  propagation. 

In  cases  where  the  growth  of  Bacillus  coli  is 
heavy,  it  is  almost  impossible  to  isolate  the  other 
organisms  which  are  visible  in  the  stained  smears. 
One  reason  for  this  is  that  Bacillus  coli,  with  its 
short  incubation  period,  rapidly  outgrows  the  more 
slowly  developing  organisms.  Another  is  that  the 
processes  affecting  all  the  bacteria  present  in  the 
colon  give  Bacillus  coli  a numerical  advantage 
even  before  defecation  takes  place. 

In  microscopic  stained  work  on  fecal  material, 
the  order  of  predominance  of  bacteria  will  usually 
be  found  to  be:  Bacillus  coli ; unclassified  organ- 
isms including  particularly  a Gram-positive,  un- 
encapsulated diplococcus;  Gram-positive  bacilli; 
Bacillus  aerogenes  capsulatus  and  Bacillus  lactis 
aerogenes ; varying  amounts  of  infective  organisms 
of  the  staphylococcus  and  streptococcus  groups; 
Gram-negative  bacilli  belonging  to  groups  other 
than  that  of  Bacillus  coli;  and,  lastly,  organisms  of 
saprophytic  origin. 


Fig.  5. — Fecal  smear  (stained  by  Gram’s  method).  Cultures  from 
this  patient  showed  an  almost  pure  strain  of  an  organism  of 
saprophytic  origin.  There  was  noticeable  irregularity  in  taking  the 
stain.  This  patient  had  a mammoth  cecum,  with  marked  hypotonia. 


CHAPTER  III 


ANATOMY  AND  PHYSIOLOGY  OF  THE  INTESTINE 

Comparative  anatomy  of  the  digestive  tract — Subdivisions 
of  the  intestinal  tube — The  valvulae  conniventes,  villi  and 
agminated  follicles — Anatomy  of  the  colon — Peristalsis — The 
mechanics  of  digestion — Reverse  peristalsis- — Existence  of 
colonic  sacculations  makes  good  drainage  essential — Digesti- 
bility of  vegetable  fibers — of  milk — The  constituents  of  the 
feces — Intestinal  secretions — Special  functions  of  the  cecum. 


CHAPTER  III 


ANATOMY  AND  PHYSIOLOGY  OF  THE  INTESTINE 

Comparative  anatomy  of  the  digestive  tract — Subdivisions 
of  the  intestinal  tube — The  valvulae  conniventes,  villi  and 
agminated  follicles — Anatomy  of  the  colon — Peristalsis — The 
mechanics  of  digestion — Reverse  peristalsis — Existence  of 
colonic  sacculations  makes  good  drainage  essential — Digesti- 
bility of  vegetable  fibers — of  milk — The  constituents  of  the 
feces — Intestinal  secretions — Special  functions  of  the  cecum. 


The  human  intestine  as  it  exists  at  present  is  the 
result  of  development  that  has  taken  place  in  re- 
sponse to  extended  or  differing  requirements.  In 
considering  the  anatomy  and  physiology  of  the  in- 
testine, it  is  well  to  keep  in  mind  the  primitive 
straight  tube  which  was  the  origin  of  our  more 
complicated  apparatus. 

We  know  that  the  length,  caliber  and  general 
construction  of  the  alimentary  canal  vary  consid- 
erably in  different  animals,  this  variation  depend- 
ing on  the  nature  of  the  food  consumed. 

The  stomach  of  the  carnivora  is  very  ample  and 
powerful  as  compared  with  that  of  the  herbivora,10 
and  the  intestine  of  the  carnivora  is  much  shorter 

and  smaller  in  volume  than  that  of  the  herbivora. 

47 


48 


COLONIC  THERAPY 


In  the  cat,  for  example,  the  entire  length  of  the 
intestine  is  only  six  or  seven  feet ; while,  in  striking 
contrast,  the  intestine  of  the  horse  is  about  one 
hundred  feet  in  length,  that  is,  ten  to  twelve  times 
the  length  of  its  body. 

In  the  adult  man,  the  length  of  the  intestine  is 
independent  of  age,  height,  or  weight;  it  is  longer 
in  vegetarians  than  in  those  who  eat  meat.  The 
small  intestine  proper  varies  considerably  in  length 
— from  fifteen  to  thirty-one  feet.  It  is  attached 
to  the  posterior  abdominal  wall  by  a fold  of  peri- 
toneum called  the  mesentery;  and  is  divided  into 
duodenum,  jejunum  and  ileum.  The  duodenum 
is  from  nine  to  eleven  inches  in  length;  is  dilated 
at  its  pyloric  origin,  and  firmly  attached  to  the 
posterior  face  of  the  liver  by  a peritoneal  fold.  It 
is  also  attached  to  the  right  of  the  lumbar  region 
by  connective  tissue.  It  describes  the  arc  of  a 
circle,  in  the  concavity  of  which  is  lodged  the  right 
extremity  of  the  pancreas. 

Jejunum  is  the  name  usually  given  to  the  second 
division  of  the  small  intestine,  and  ileum  to  that  of 
the  third;  that  is,  the  section  opening  into  the  large 
intestine.  Many  anatomists  refer  to  the  whole 
region  between  the  duodenum  and  the  head  of  the 
cecum  as  the  jejuno-ileum.  The  duodenum  is  the 
most  firmly  fixed  part  of  the  small  intestine,  the 
jejunum  and  the  ileum  following  no  definite  or 
constant  course,  their  folds  appearing  in  different 


ANATOMY  AND  PHYSIOLOGY  OF  INTESTINE  49 

places  in  normal  subjects.  The  termination  of  the 
ileum  is  at  the  junction  with  the  cecum  in  the  right 
iliac  fossa,  the  entrance — as  has  already  been 
noted — being  guarded  by  the  ileocecal  valve.  The 
villi  and  valvulae  conniventes  are  found  throughout 
the  jejuno-ileum.11 

The  recognized  subdivisions  of  the  large  intes- 
tine are  the  cecum,  the  colon  and  the  rectum. 

In  the  cat  family,  the  cecum  forms  only  a small, 
spirally  twisted  appendix;  while  in  the  herbivora, 
the  cecum  serves  as  a reservoir  for  the  enormous 
quantities  of  fluid  ingested,  and  for  the  food  while 
undergoing  bacterial  decomposition.  In  man, 
the  cecum,  which  is  located  in  the  right  iliac  fossa, 
is  directed  somewhat  obliquely  downward  and  to 
the  left.  It  commences  at  the  ileocecal  valve, 
varies  in  length,  and  terminates  by  a rounded  ex- 
tremity in  a small,  hollow  prolongation,  the  cecal 
or  vermifoj'm  appendix. 

The  human  colon,  which  measures  from  twenty- 
five  to  fifty-four  inches  in  length,  begins  in  the 
right  iliac  fossa  above  Bauhin’s  valve  ( ileocecal 
valve) ; it  ascends  to  the  lower  face  of  the  liver, 
passes  abruptly  across  from  right  to  left,  and  at 
the  spleen  takes  a downward  course  to  the  iliac 
fossa;  it  then  describes  the  iliac  S , in  order  to  reach 
the  mesial  line,  where  it  has  its  continuation  in  the 
rectum, — the  fixed  terminal  section  of  the  large 
intestine.  In  this  course,  the  colon  is  divided  into 


50 


COLONIC  THERAPY 


three  portions:  the  ascending  colon , the  transverse 
colon , and  the  descending  colon.  The  muscular 
coat  (tunica  muscularis)  of  the  colon  consists  of 
an  external  longitudinal,  and  an  internal  circular 
layer  o/  nonstriped  muscular  fibers. 

The  longitudinal  fibers  do  not  form  a continuous 
layer  over  the  whole  surface  of  the  large  intestine. 
In  the  cecum  and  colon  they  are  especially  collect- 
ed into  three  flat  longitudinal  bands  (taenia  coli), 
each  about  12  mm.  in  width;  one,  the  posterior,  is 
placed  along  the  attached  border  of  the  intestine; 
the  anterior,  the  largest,  corresponds  along  the 
arch  of  the  colon  to  the  attachment  of  the  greater 
omentum,  but  is  in  front  in  the  ascending,  descend- 
ing, and  iliac  parts  of  the  colon ; and  in  the  sigmoid 
colon  the  third,  or  lateral  band,  is  found  on  the 
medial  side  of  the  ascending  and  descending  parts 
of  the  colon,  and  on  the  under  aspect  of  the  trans- 
verse colon.  These  bands  are  shorter  than  the 
other  coats  of  the  intestine,  and  serve  to  produce 
the  sacculi  which  are  characteristic  of  the  cecum 
and  colon.  In  the  sigmoid  colon  the  longitudinal 
fibers  become  more  scattered,  and  around  the  rec- 
tum they  spread  out  and  form  a layer,  which  com- 
pletely encircles  this  part  of  the  gut,  but  is  thicker 
on  the  anterior  and  posterior  surfaces — where  it 
forms  two  bands — than  on  the  lateral  surfaces 
(Gray). 

Comparing  the  human  colon  with  that  of  the 


ANATOMY  AND  PHYSIOLOGY  OF  INTESTINE  51 

carnivora  and  of  the  herbivora,  we  find  that  the 
colon  of  the  cat  is  scarcely  larger  than  the  small 
intestine,  and  is  neither  sacculated  nor  furnished 
with  longitudinal  bands ; whereas,  the  horse’s  colon 
is  about  twenty-three  feet  long;  it  is  traversed  by 
longitudinal  bands,  and  is  sacculated  and  furrowed 
transversely  for  a great  part  of  its  extent,  these 
sacculations  and  furrows  beginning  in  the  cecum. 

Upon  the  internal  face  of  the  small  intestine  are 
a large  number  of  folds  or  rugae,  the  valvulae  con- 
niventes,  which  enormously  increase  the  area  of 
absorption. 

The  alimentary  canal  also  possesses  secretory 
elements.  Among  these  are  the  villi — long,  finger- 
like projections  which  occur  on  the  internal  sur- 
face of  the  small  intestine,  particularly  the  upper 
part.  These  villi  vary  much  in  form  in  different 
mammals  and  in  different  portions  of  the  tract  of 
the  same  individual.  In  man  the  villi  are  said  to 
be  millions  in  number;  the  vast  majority  are  coni- 
cal in  shape,  the  base  being  slightly  broader  than 
the  free  extremity.  In  the  duodenum,  however, 
they  possess  a foliate  shape,  while  in  the  ileum 
some  of  the  villi  are  clavate.  The  villus  is  formed 
by  a projection  of  the  corium  which  is  covered  by 
the  lining  epithelium  of  the  intestine.  The  axis  of 
the  villi  contains  a large  lymphatic  tube  or  lacteal , 
which  begins  in  the  inner  third  and  proceeds  out- 
ward through  the  corium  to  enter  a lymphatic 


52 


COLONIC  THERAPY 


plexus  lying  just  within  the  muscularis  mucosae. 
Many  of  these  fibers  turn  outward  and  are  at- 
tached to  the  basement  membrane  beneath  the 
epithelium  at  the  sides  and  tip  of  the  villus.  By 
their  rhythmic  contraction,  the  muscle  fibers  of 
the  villus  aid  in  expelling  the  contents  of  the 
lacteal. 

Each  villus  is  supplied  with  one  or  more  arte- 
rioles which  enter  at  the  base  and  pass  to  the  inner 
third,  where  they  form  an  abundant  capillary 
plexus  about  the  blind  extremity  of  the  lacteal, 
and  in  the  apex  of  the  villus.  Minute  venules  col- 
lect the  blood  from  this  plexus  and,  following  the 
course  of  the  lacteal,  make  their  exit  from  the  base 
of  the  villus  to  join  the  venous  plexus  in  the  deeper 
part  of  the  mucosa. 

The  corium  of  the  small  intestine,  which  makes 
up  the  substance  of  the  intestinal  villi,  consists  of 
a fibrorecticular  stroma  which  is  so  infiltrated  with 
leucocytes  as  to  constitute  a diffuse  lymphoid  tis- 
sue. In  many  parts  of  the  mucosa,  the  lymphoid 
tissue  forms  isolated  nodules,  the  solitary  follicles. 
Aggregations  of  these  follicles,  which  often  occur, 
are  known  as  the  agminated  follicles , agminated 
glands , or  Peyers  patches.  The  constituent  fol- 
licles in  one  of  these  Peyer’s  patches  number 
fifteen  or  twenty,  and  each  nodule  is  usually  cov- 
ered by  a thin,  fibrous  capsule,  but  two  or  more 
may  be  confluent.  Peyer’s  patches,  numbering 


ANATOMY  AND  PHYSIOLOGY  OF  INTESTINE  53 

from  twenty  to  twenty-five  in  all,  ordinarily  occur 
in  that  portion  of  the  intestinal  mucosa  which  is 
farthest  removed  from  the  attachment  of  the 
mesentery,  being  most  frequently  in  the  ileum, 
especially  in  the  neighborhood  of  the  ileocecal 
valve.  They  often  produce  oval  areas  large 
enough  to  be  seen  with  the  naked  eye. 

The  long  axes  of  the  ovoid  nodules  exceed  the 
average  thickness  of  the  mucous  membrane,  so  that 
the  patch  forms  a superficial  elevation  of  the 
mucosa,  and  its  deeper  surface  penetrates  the 
muscularis  mucosae  and  enters  the  submucous  coat. 
Hence,  occasional  fragments  of  the  muscularis 
mucosae  are  often  observed  between  the  bases  of 
the  constituent  nodules.  Villi  are  found  upon  the 
free  surface  of  the  follicles  only  in  the  intervals 
between  the  constituent  nodules.  The  largest 
nodules  lie  near  the  center  of  the  patch;  the  small- 
est appear  at  its  periphery.12  Solitary  follicles 
occur  throughout  both  the  large  and  the  small 
intestines,  while  Peyer’s  patches  are  found  only 
in  the  small  intestine. 

The  cecum  in  both  man  and  the  lower  animals 
is  lined  by  a plicated  and  very  follicular  mucous 
membrane;  in  the  cat  family,  the  cecum  shows  at 
the  bottom  of  the  cul-de-sac  a true  Peyer’s  gland. 

The  ileocecal  valve  consists  of  two  folds  of  mu- 
cous membrane  with  muscle  fibers  between  the 
layers.  These  folds  lie  at  the  end  of  the  ileum, 


54 


COLONIC  THERAPY 


where  it  opens  into  the  colon,  and  project  toward 
each  other  across  the  lumen,  so  that  only  a slit-like 
passage  remains  open. 

The  colon  begins  at  the  ileocecal  valve.  The 
first  part,  or  ascending  colon,  passes  upward  in 
the  right  lumbar  region.  After  making  a bend 
under  the  liver — the  right  colic  flexure  (or  hepatic 
flexure) — it  becomes  the  ‘transverse  colon,  which 
passes  straight  across  the  abdomen  in  front  of  the 
small  intestine.  Another  bend  occurs  under  the 
spleen,  the  left  colic  flexure  (or  splenic  flexure)  ; 
thence  the  descending  colon  passes  downward  in 
the  left  lumbar  region  to  the  left  iliac  fossa.  Here 
it  makes  an  S -shaped  or  sigmoid  bend,  which  is 
called  the  sigmoid  colon.  Then,  as  it  enters  the 
pelvis,  it  becomes  the  rectum. 

The  rectum  is  from  five  to  seven  inches  long, 
very  distensible,  and  receives  its  name  from  the 
Latin  rectus  (straight)  because,  unlike  the  other 
portions  of  the  large  intestine,  it  has  no  convolu- 
tions, but  simply  follows  the  curve  of  the  pelvic 
wall,  lying  in  front  of  the  sacrum  and  coccyx.  In 
the  last  inch  and  a half  it  bends  backward  (peri- 
neal flexure)  to  pass  the  tip  of  the  coccyx.  This 
is  the  anal  canal,  ending  in  the  external  opening 
called  the  anus.13 

The  rectum  is  sacculated,  usually  presenting, 
when  distended,  three  dilatations,  of  which  the 
lowest  and  largest,  called  the  ampulla,  may  meas- 


ANATOMY  AND  PHYSIOLOGY  OF  INTESTINE  55 

ure  nine  inches  or  more  in  circumference.  The 
saccules  are  separated  by  deep  creases,  passing 
about  two-thirds  around  the  intestine,  the  so-called 
“valves  of  the  rectum.”  14 

The  basic  factors  upon  which  the  movements  of 
our  alimentary  canal  depend  are  the  peristaltic 
waves  and  their  gradients. 

Peristalsis  is  the  name  given  to  the  peculiar 
motion  of  the  stomach  and  intestine  during  the 
passage  of  their  contents.  The  circular  fibers  com- 
press the  food  and  at  the  same  time  the  longitudinal 
fibers  shorten  the  tube.  This  action  goes  on  from 
above  downward,  causing  a sort  of  worm-like 
movement  which  is  described  as  peristalsis , or 
peristaltic  movement.  The  peristaltic  action  of 
the  bowel  is  made  more  effective  by  the  presence 
of  a reasonable  amount  of  material  upon  which  it 
can  act.  This  explains  why  a certain  amount  of 
so-called  “rough  foods”  should  always  be  ingested 
and  why  restricting  the  diet  to  material  carefully 
refined  and  prepared  beforehand  leads  to  many 
digestive  ills. 

Alvarez  16  has  clearly  established  that  the  di- 
gestive tract  is  highly  autonomous  and  that  the 
mechanism  which  produces  peristalsis  is  found  in 
the  wall  of  the  intestine.  These  waves,  together 
with  the  process  of  digestion  and  absorption,  begin 
in  the  mouth  and  end  at  the  anus.  In  the  course 
of  this  mechanical  motor  process,  the  conveyed 


56 


COLONIC  THERAPY 


material  has  its  points  of  relay  and  undergoes  cer- 
tain endocrine  chemical  changes.  Therefore,  in 
order  to  follow  this  process  intelligently,  we  should 
know  the  points  throughout  the  entire  length  of 
the  tube  at  which  absorption  of  different  food  sub- 
stances takes  place.  It  is  upon  this  principle  of 
absorption  that  many  drugs  are  administered. 

There  is  no  doubt  that  the  waves  of  the  ileum 
stimulate  the  cecum,  but  the  terminal  ileum  is  not 
alone  the  receptacle  of  the  ileum  residue,  which 
undergoes  a change  upon  entering  the  cecum,  but 
is,  moreover,  a terminal  point  of  the  stomach  waves 
which  also  undergo  a change  at  this  point,  and  are 
largely  instrumental  in  producing  the  churning 
movements  of  the  cecum.  It  is,  however,  the  trac- 
tion muscles  which  are  the  most  powerful  aid  in 
advancing  mass  movements  of  the  residue  travers- 
ing the  colon.  In  the  cat,  because  the  stomach  is 
very  powerful  and  the  intestine  very  short,  the 
stomach  waves  are  sufficient  to  carry  to  the  rectum 
the  small  amount  of  residue  resulting  from  this 
animal’s  high  protein  meat  diet,  and,  therefore,  no 
traction  bands  for  contracting  the  colon  are  re- 
quired. In  the  horse,  however,  as  the  stomach 
waves  are  comparatively  weak,  they  are  unable  to 
move  the  enormous  amount  of  residue  accumulated 
in  the  long  colon;  therefore,  the  bands  of  the  trac- 
tion muscles  are  necessary  to  exert  traction  by  a 
contracting  movement.  In  man,  it  is  illogical  to 


ANATOMY  AND  PHYSIOLOGY  OF  INTESTINE  57 

believe  the  stomach  contractions  powerful  enough 
— considering  gradients — to  produce  waves  suffi- 
ciently strong  to  empty  the  colon,  without  the  in- 
tervention of  other  forces. 

It  is  my  experience  that  the  traction  muscles  of 
the  colon  have  a most  important  function.  The 
longitudinal  layer  of  muscular  tissue  is  arranged 
much  like  a tape  from  the  cecum  to  the  sigmoid 
flexure.  The  function  of  these  muscle  fibers  is  to 
relax  and  shorten  the  intestine  and  to  contract  it 
to  within  three-quarters  of  its  relaxed  length,  thus 
raising  the  cecum  as  high  as  the  hepatic  flexure. 
Therefore,  we  must  deal  with  the  colon,  not  by 
considering  each  section  separately,  but  by  regard- 
ing it  as  an  organ  similar  to  the  stomach,  having 
three  major  divisions,  but  powerful  enough  to 
empty  its  entire  length  down  to  the  sigmoid  by  one 
convulsive  contraction. 

The  nerves  which  control  the  colon  form  a part 
of  the  pelvic  plexus  which  supplies  the  various 
abdominal  viscera.  This  pelvic  plexus  is  in  turn 
part  of  the  sympathetic  nervous  system,  which  has 
its  comiection  with  the  spinal  nerves  by  means  of 
what  are  known  as  rami  communicantes.  The 
nerve  supply  of  the  rectum  is  more  abundant  than 
that  of  the  colon.  In  addition  to  the  slow  laborious 
peristaltic  movements  of  the  colon,  so  thoroughly 
described  by  many  authors,  it  has  likewise  the 


58 


COLONIC  THERAPY 


power  of  traction  from  below.  This  will  be  further 
discussed  in  connection  with  fecal  stasis. 

More  than  a quarter  of  a century  ago,  Jacobi 16 
observed  that  the  intestine  possesses  not  only  the 
propulsive  power  which  we  call  peristalsis,  but  a 
reverse  movement  or  antiperistalsis,  an  impulse 
occurring  at  regular  intervals  whenever  the  cecum 
has  a fluid  content.  Cannon  17  later  made  a special 
study  of  this  reverse  peristalsis  as  it  occurs  in  cats 
and,  more  recently,  extensive  x-ray  observations 
have  been  made  by  Case  18  upon  human  subjects. 
These  rhythmic  reverse  movements  are  interrupted 
at  regular  intervals  by  a downward  peristalsis,  but 
it  is  the  action  of  the  ileocecal  valve  alone  which 
keeps  the  contents  of  the  cecum  from  being  forced 
backward  into  the  small  intestine  every  time  re- 
verse peristalsis  takes  place.  In  the  intervals  be- 
tween the  backward  waves,  however,  the  valve  re- 
laxes so  that  some  of  the  intestinal  content  is  able 
to  pass  into  the  cecum.  This  action  appears  to  be 
largely  instrumental  in  churning  up  the  liquid 
material  and  spreading  it  over  the  surface  of  the 
cecum  and  ascending  colon,  thus  favoring  absorp- 
tion of  fluid  and  the  shaping  and  drying  of  the 
residue  which  is  being  passed  downward  through 
the  intestine. 

In  addition  to  peristalsis  both  downward  and 
reverse,  the  carbonic  acid  and  other  gases  which 
are  generated  in  the  digestive  tract  through  the 


ANATOMY  AND  PHYSIOLOGY  OF  INTESTINE  59 

action  of  bacterial  ferments  upon  starch,  cellulose 
and  similar  materials,  play  the  part  of  a powerful 
stimulus  to  the  muscular  activities  of  the  colon. 

In  the  normal  cecum,  these  gases  produce  a con- 
stant distention  and  contraction  of  the  organ  which 
continues  throughout  the  entire  length  of  the 
colon.  In  its  true  physiologic  state,  the  colon’s 
entire  length  is  characterized  by  slight  depressions 
or  pockets  into  which  the  intestinal  contents  are 
pressed  by  peristaltic  action  and  the  force  of  the 
gases  present  in  the  intestine,  so  that  fluid  is  con- 
stantly absorbed  from  the  mass,  and  its  consistency 
continually  changes  as  it  advances  through  the 
colon.  A comprehension  of  these  facts  makes  it 
easy  to  understand  why  the  maintenance  of  good 
drainage  of  the  entire  alimentary  tract  is  so  essen- 
tial to  health  and  proper  metabolism.  Given  the 
constant  presence  of  fermentative  and  putrefac- 
tive bacteria,  the  action  of  peristalsis,  and  the 
structure  of  the  colonic  tube,  anything  which  in- 
terferes— even  to  a minute  degree — with  the  regu- 
lar expulsion  of  the  waste  products  of  the  digestive 
process  is  practically  certain  to  have  grave  results. 

Comparing  the  human  digestive  apparatus  to 
that  of  the  lower  animals,  it  will  be  observed  that 
our  stomachs  readily  digest  meat  and  other  foods 
of  high  protein  content,  but  that  fruit  fibers,  such 
as  those  of  prunes,  grape-fruit,  and  oranges,  or 
vegetable  residue,  such  as  that  of  celery,  asparagus 


60 


COLONIC  THERAPY 


fiber*  and  spinach  in  particular,  are  not  acted  upon 
so  thoroughly.  I find  that  spinach  is  rarely,  if 
ever,  digested,  and  in  most  cases  it  will  be  found  in 
the  colon  in  great  wads  showing  a markedly  acid 
reaction.  It  is  stated  by  a French  writer  that  the 
human  system  is  only  capable  of  absorbing  Y&2 
grain  of  iron,  and  as  this  amount  is  contained  in 
a single  teaspoonful  of  spinach,  it  may  be  con- 
cluded from  this  that  a teaspoonful  of  spinach  is 
a sufficient  addition  to  our  diet.  Lettuce  leaves 
a small  residue  in  the  form  of  soft  fiber;  tomatoes 
are  readily  digested  except  that  the  skins  are  oc- 
casionally passed  unchanged,  but  mushrooms  are 
always  found  in  the  stool  wholly  unaffected  bjT  the 
digestive  processes. 

Kellogg  says  of  milk,  “Within  the  last  few  years 
much  evidence  has  accumulated  to  the  effect  that 
cow’s  milk  is  by  no  means  the  specially  wholesome 
human  nutriment  that  it  was  once  supposed  to  be. 
Bunge,  a great  physiologist,  and  perhaps  one  of 
the  world’s  highest  authorities  on  foods,  goes  so 
far,  indeed,  as  to  assert  that  many  thousands  of 
children  are  annually  killed  by  feeding  on  cow’s 
milk;  and  many  persons  have  learned  from  their 
own  observation  that  milk  does  not  agree  with  , 
them.  Cow’s  milk  is  excellent  food  for  calves,  to 
which  it  is  naturally  adapted,  but  for  many  human 
adults  it  appears  to  behave  almost  as  a poison. 
The  probable  cause  is  the  very  common  inability 


ANATOMY  AND  PHYSIOLOGY  OF  INTESTINE  61 

to  digest  the  casein  of  cow’s  milk.  Personal  ob- 
servation in  a very  large  number  of  cases  has  con- 
vinced the  writer  that  at  least  one-third,  and  prob- 
ably more  than  one-half,  of  the  persons  suffering 
from  chronic  disease  cannot  use  cow’s  milk  freely 
without  more  or  less  serious  injury.  One  of  the 
prominent  symptoms  arising  from  the  use  of  cow’s 
milk  is  the  production  of  a condition  commonly 
known  as  ‘biliousness.’  The  tongue  becomes 
coated,  there  is  a had  taste  in  the  mouth,  the  breath 
is  foul,  the  bowels  are  inactive,  and  an  examination 
of  the  stools  shows  the  presence  of  considerable 
quantities  of  undigested  casein  undergoing  putre- 
faction. 

“The  free  use  of  milk  is  unknown  among  sav- 
ages. The  writer  has  no  doubt  that  the  extensive 
use  of  milk,  under  the  mistaken  notion  that  it  is 
a specially  valuable  food  for  adults  as  well  as  for 
infants,  is  one  of  the  active  causes  of  the  steady 
increase  of  constipation  amongst  civilized  people. 
Putrefaction  of  undigested  casein  in  the  colon  pro- 
duces an  alkaline  condition  which  paralyzes  the 
bowel  and  encourages  conditions  by  which  the 
defecating  mechanism  is  in  various  ways  more  or 
less  irreparably  damaged.”  19 

Some  of  the  most  difficult  impactions  of  the 
colon  that  I have  been  called  upon  to  remove  have 
been  the  result  of  a milk  diet.  On  one  occasion  it 
was  necessary  to  use  twenty-six  gallons  of  solution 


62 


COLONIC  THERAPY 


to  remove  such  an  impaction.  This  impaction, 
added  to  the  irrigating  fluid,  produced  a heavy 
whitish  return  of  very  offensive  odor;  and  the  total 
quantity  of  feces  and  water  measured  twenty- 
seven  gallons.  A certain  amount  of  fluid  was  ab- 
sorbed and  this  was  not  accounted  for  in  these 
calculations.20 

As  we  have  accustomed  ourselves  to  selected 
foods  of  highly  protein  content  made  soft  by 
culinary  preparation,  our  digestive  tracts  no 
longer  possess  the  qualities  necessary  to  digest 
roughage.  The  reason  that  we  still  have  compara- 
tively large  colons  is  not  from  the  quality  of  the 
food  which  we  ingest;  it  is  because  of  the  quantity, 
the  result  of  overstimulation  of  the  palate,  which 
must  eventually  produce  definite  changes  in  the 
human  alimentary  canal.  To  take  care  of  the 
food  man  ordinarily  attempts  to  consume  he  would 
require  the  stomach  of  a wildcat  and  the  intestines 
of  a horse. 

When  we  do  not  overeat,  the  undigested  food 
or  residue  forms  but  a small  portion  of  our  feces, 
the  chief  bulk  being  made  up  of  secretions  or  ex- 
cretions of  the  intestinal  canal  with  the  addition  of 
bacteria.  Cammidge  has  described  the  usual  con- 
stituents of  the  feces  as  follows: 

1.  Remnants  of  the  food  that  have  escaped  absorption. 

2.  Remnants  of  the  food  which  are  relatively  or  entirely  indi- 
gestible. 


ANATOMY  AND  PHYSIOLOGY  OF  INTESTINE  63 

S.  The  secretions  of  the  intestinal  mucous  membrane  and  of 
the  digestive  glands. 

4.  Cell  elements  and,  under  pathologic  conditions  especially, 
mucus,  serum,  red  blood-corpuscles  and  leukocytes. 

5.  The  products  of  the  splitting  up  of  the  foodstuffs,  some 
due  to  the  effects  of  ferments,  others  arising  from  the 
action  of  the  bacteria. 

6.  Excretory  products  of  the  intestinal  mucous  membrane, 
such  as  salts  of  calcium,  iron  and  possibly  other  metals,  etc. 

7-  The  bacterial  flora  of  the  intestine. 

8.  Adventitious  additions  to  the  stools,  such  as  intestinal 
parasites  or  their  eggs,  enteroliths,  gall-stones,  etc. 

This  applies  to  the  feces  of  infants  and  children, 
as  well  as  to  adults,  although  the  relative  propor- 
tions of  the  individual  ingredients  are  necessarily 
different  at  different  ages  and  under  varying  con- 
ditions, the  most  noteworthy  contrast  existing 
between  the  stools  during  the  first  few  months  and 
in  later  life. 

“A  careful  estimation  of  the  daily  average 
amount  of  the  feces  passed,  when  compared  with 
the  standard  figures  for  successive  periods  of  life 
and  for  different  dietaries,  affords  a very  useful 
indication  of  the  way  in  which  the  alimentary  canal 
is  performing  its  functions.  This  is  true  for  the 
infant  before  weaning,  for  older  children,  and  also 
for  adults,  if  the  differences  that  result  from  diets 
consisting  of  breast  milk,  cow’s  milk,  and  various 
types  of  solid  food,  etc.,  are  borne  in  mind. 

“The  digestive  functions  of  the  stomach  influ- 
ence the  bulk  of  the  feces  very  little,  even  complete 


64 


COLONIC  THERAPY 


achylia  gastrica  causing  scarcely  any  modification. 
Failure  of  the  digestive  secretions  of  the  intestine 
giving  rise  to  an  increased  proportion  of  undi- 
gested fat  or  albumin  in  the  stools  is  among  the 
commonest  causes  of  an  increase  in  their  bulk.  . . . 
The  amount  may  also  be  increased  by  admixture 
with  pathological  products  coming  from  the  intes- 
tinal wall  or  elsewhere,  such  as  mucus,  blood,  pus, 
serum,  etc.  . . . Conditions  favoring  abnormal 
putrefactive  or  fermentative  changes  in  the  intes- 
tinal contents  may  increase  the  bulk  of  the  feces 
by  causing  proliferation  of  the  bacteria. 

“Adults  and  children  taking  a solid  mixed  diet 
have,  as  a rule,  one  or  two  motions  of  the  bowels 
daily,  but  even  under  physiological  conditions  the 
number  is  subject  to  wide  variations.  . . . Psychi- 
cal, general,  and  reflex  nervous  influences  have  an 
important  bearing  on  the  frequency  with  which 
the  bowels  are  opened  . . . the  time  spent  by  the 
food  in  the  intestines  bears  no  particular  relation- 
ship to  the  frequency  of  the  evacuations.  . . . The 
time  of  passage  of  the  food  through  the  alimentary 
canal  is  much  less  in  infants  than  in  adults — 
usually  from  one-third  to  one-quarter.  It  is  prob- 
ably owing  to  this  rapid  passage  that  certain 
phenomena,  such  as  reduction  and  putrefaction,  do 
not  occur  in  infants  with  the  same  intensity  as  in 
older  people. 

“In  health,  the  form  and  consistency  of  the  feces 


ANATOMY  AND  PHYSIOLOGY  OF  INTESTINE  65 

is  mainly  determined  by  the  quantity  of  water  they 
contain,  and  is  hence  largely  dependent  upon  the 
nature  of  the  ingesta.  With  a mixed  diet  they 
exhibit  a characteristic  cylindrical  form  and  are  of 
fairly  firm  consistency.  . . . Abnormally  soft  mo- 
tions occur  when  there  is  an  excess  of  fluid,  fat  or 
mucus,  and  when  a large  amount  of  vegetable 
material  is  taken  . . . the  formation  of  gas,  and 
the  irritating  action  of  the  bacterial  products  are 
much  more  pronounced  with  certain  foods  than 
with  others.”  21 

In  the  carnivora  (cat),  the  stomach  secretes  a 
gastric  fluid  throughout  the  whole  extent  of  its 
mucous  membrane.  In  the  horse,  the  action  of  the 
stomach  is  insignificant  as  compared  to  that  of  the 
enormous  colon,  which  is  capable  of  digesting  and 
absorbing  large  quantities  of  food  and  water. 

The  intestinal  secretions  have  been  extensively 
studied  without  arriving  at  definite  conclusions  as 
to  their  exact  ingredients.  A true  physiologic, 
secretory  process  is  carried  on  by  the  fluids  of  the 
intestinal  villi  and  their  numerous  glands,  acting 
upon  the  food  consumed. 

Secretion  of  intestinal  fluids  can  be  stimulated 
by  the  action  of  certain  chemicals  upon  the  glands 
of  the  intestine.  Mechanical  stimulation  of  the 
alimentary  canal  results  from  the  chewing  and 
swallowing  of  food,  or  sometimes  from  the  use  of 
instruments.  The  small  intestine  with  its  equip- 


66 


COLONIC  THERAPY 


ment  of  millions  of  villi  fistulae  is  capable  of  se- 
creting and  absorbing  a variety  of  substances, 
while  the  colon  with  fewer  villi  digests  and  absorbs 
much  less,  the  greater  part  of  the  absorption  in  the 
large  intestine  being  accomplished  by  the  cecum. 
This  part  of  the  digestive  tube  harbors  the  greatest 
quantity  of  living  bacteria,  some  of  which  aid 
digestion,  while  others  produce  an  active  putre- 
faction. 

As  the  cecum  has  both  a chemical  and  a mechani- 
cal function,  even  if  it  is  not  of  great  value  to  the 
body  as  a whole,  its  presence  in  the  alimentary 
canal  is  indispensable.  The  disturbances  suffered 
from  an  overloaded  cecum  are  similar  to  those  re- 
sulting from  an  overloaded  stomach.  A sensation 
of  fulness  in  the  abdomen  is  often  produced  by 
regurgitation  or  “backfire”  of  the  gases  and  resi- 
due forced  through  the  ileocecal  valve  into  the 
ileum. 


CHAPTER  IV 


THE  RELATION  OF  COLONIC  PATHOLOGY  TO  SYSTEMIC 
INFECTION 

Chemical  changes  induced  by  disease — The  theory  of  focal 
infection — The  endocrine  glands— “Errors  of  metabolism” — 
Infective  foci  not  always  located  in  the  head — Stokes  on 
causes  of  colitis^ — Abolition  of  colonic  stasis  must  precede  any 
form  of  therapy — Health  and  proper  function  dependent 
upon  elimination  of  toxic  products — Autonomy  of  the  gastro- 
intestinal tract — Purpose  of  colonic  irrigation  the  establish- 
ment of  thorough  drainage — Inefficacy  of  catharsis — The 
colon  a neglected  and  despised  organ,  but  capable  of  “ref- 
ormation”— Intestinal  interlining  adhesions — Case  on  pa- 
thology of  the  colon — Diverticula — Their  occurrence  in  the 
obese — Symptoms  of  pathologic  lesions. 


CHAPTER  IV 


THE  RELATION  OF  COLONIC  PATHOLOGY  TO  SYSTEMIC 
INFECTION 

Chemical  changes  induced  by  disease — The  theory  of  focal 
infection — The  endocrine  glands — “Errors  of  metabolism” — 
Infective  foci  not  always  located  in  the  head — Stokes  on 
causes  of  colitis — Abolition  of  colonic  stasis  must  precede  any 
form  of  therapy — Health  and  proper  function  dependent 
upon  elimination  of  toxic  products — Autonomy  of  the  gastro- 
intestinal tract — Purpose  of  colonic  irrigation  the  establish- 
ment of  thorough  drainage — Inefficacy  of  catharsis — The 
colon  a neglected  and  despised  organ,  but  capable  of  “ref- 
ormation”— Intestinal  interlining  adhesions — Case  on  pa- 
thology of  the  colon — Diverticula — Their  occurrence  in  the 
obese — Symptoms  of  pathologic  lesions. 


Our  knowledge  of  the  alimentary  canal  and  the 
endocrine  chemistry  of  the  normal  human  subject 
is  limited  enough.  But  when  disease  has  affected 
the  anatomical  structure  of  the  digestive  tube  and 
has  interfered  with  the  endocrine  secretions  and 
intestinal  juices,  varying  chemical  changes  occur 
which  make  it  almost  impossible  to  arrive  at  any 
classification.  It  will  be  readily  appreciated  how 
difficult  would  be  any  attempt  to  analyze  the  in- 
testinal secretions  and  to  compare  their  constitu- 

69 


70  COLONIC  THERAPY 

ents  with  those  of  the  blood  or  urine.  Neverthe- 
less, I have  been  prompted  to  attempt  the  analysis 
of  intestinal  secretions,  intestinal  gases,  the  gases 
and  exudates  expelled  by  the  lungs,  the  excretions 
of  the  skin,  and  also  an  analysis  of  the  urine  and 
blood.  From  so  complete  an  investigation  we 
ought  to  obtain  data  that  would  enable  us  to  arrive 
at  a more  definite  conclusion  in  regard  to  our  body 
chemistry  and  its  alterations. 

The  most  important  factor  is  the  chemical 
change  that  takes  place  during  disease;  but,  in 
order  to  recognize  the  changed  conditions,  we  must 
first  know  the  mechanism,  and  be  thoroughly  fa- 
miliar, not  alone  with  the  chemistry  of  the  body, 
but  its  excretions  also,  as  there  is  no  doubt  that  the 
retardation  of  bodily  excretions  is  the  greatest 
obstacle  in  combating  disease.  When  disease 
conditions  confront  us,  the  metabolic  output  is  of 
far  more  importance  than  the  metabolic  intake. 

During  the  past  ten  years  the  question  of  foci 
of  infection  as  a cause  of  systemic  disease  has  been 
widely  considered  and  very  thoroughly  studied 
and  discussed.  Especially  has  the  subject  of  foci 
of  infection  located  in  the  head  been  investigated 
from  every  conceivable  standpoint,  anatomical, 
pathologic,  surgical  and — one  ahnost  ventures  to 
say — financial.  In  fact,  it  seems  that  every  known 
disease  has  been  attributed  to  some  form  of  focal 


sepsis. 


Fig.  6. — Section  of  intestinal  interlining  adhesion,  removed  from  the 
transverse  colon  through  a rectal  tube.  Macroscopic  examination 
showed  about  120  c.c.  light  brown  feces,  containing  strips  of  smooth, 
soft,  grayish  material,  varying  in  length  from  1 to  6 cm.,  about 
2 cm.  in  depth,  and  having  an  average  width  of  about  1 cm. 
Microscopically,  without  staining,  strips  of  fibrin  enmeshing  red 
blood-cells  and  desquamated  epithelium  were  visible.  On  section, 
irregular  strips  of  fibrin  were  seen,  with  necrotic  debris,  containing 
red  blood-cells  and  desquamated  epithelium. 


COLONIC  PATHOLOGY  AND  SYSTEMIC  INFECTION  71 

Very  recently,  the  attention  of  the  medical  pro- 
fession has  been  centered  upon  the  part  played  in 
the  mechanism  and  function  of  the  human  body, 
by  the  endocrine  glands,  and  errors  in  metabolism 
have  been  held  responsible  for  all  human  ills. 
That  the  practice  of  medicine  is  not  entirely  free 
from  fads  can  hardly  be  denied;  yet  a thoughtful 
consideration  will  easily  convince  us  that  the  put- 
ting forward  of  these  different  causative  factors 
of  disease  is  but  a constant  march  along  the  line 
of  progress,  and  that  the  theories  of  focal  infection 
and  errors  in  metabolism,  far  from  being  contra- 
dictory, serve  to  confirm  and  strengthen  each 
other,  so  that  each  but  demonstrates  the  soundness 
of  the  premise  on  which  the  other  is  based. 

Intensive  study  of  the  endocrine  system  has 
called  attention  to  the  fact  that  foci  of  infection 
are  not  necessarily  or  by  any  means  invariably 
located  in  the  head.  While  this  fact  has  been  well 
understood,  it  has  not  seldom  been  entirely  neg- 
lected, and  the  very  areas  from  which  infection  is 
being  disseminated  have  been  regarded  as  being 
themselves  infected  by  some  unlocated  focus  situ- 
ated in  the  head.  The  occurrence  of  a cholecystitis 
or  a prostatitis  has  been  attributed  to  bad  teeth  or 
diseased  tonsils,  when  in  reality  it  was  exactly  the 
other  way  about,  the  actual  focus  from  which  the 
toxins  were  being  generated  lying  in  the  digestive 
or  genital  tract,  and  the  oral  or  tonsillar  conditions 


72 


COLONIC  THERAPY 


being  but  a reflex  result  of  this  systemic  infection. 
That  colonic  stasis  has  been  proved  responsible  for 
many  focal  infections  and  endocrine  disturbances 
admits  of  no  contention. 

At  a recent  meeting  of  the  American  Electro- 
Therapeutic  Association,  Charles  F.  Stokes  took 
occasion  to  remark,  during  a discussion  on  colitis, 
that  in  many  of  these  cases  the  endocrine  system  is 
depleted,  and  the  general  metabolism  suffers  in 
consequence.  Because  the  conditions  existing  in 
the  colon  are  so  frequently  overlooked,  many  futile 
efforts  are  made  to  treat  these  local  and  general 
evidences  of  endocrine  imbalance.  Almost  every- 
one, nowadays,  searches  for  focal  infection  along 
the  avenue  of  “metabolic  intake'’ — the  naso- 
pharynx, the  sinuses,  the  mouth,  teeth,  tonsils,  and 
respiratory  tract;  but  the  avenue  of  metabolic 
outlet— the  colon,  and  the  genito-urinary  canal — 
receive  only  scant  consideration.  Especially  is  this 
the  fact  when  there  is  a psychic  element  involved, 
a frequent  occurrence  in  all  cases  of  endocrine 
dysfunction.  In  Dr.  Stokes’  opinion,  the  biologic 
approach  seems  to  give  us  the  clearest  understand- 
ing of  these  problems,  inasmuch  as  it  brings  home 
the  conviction  that  it  is  erroneous  to  consider  these 
lesions  as  of  purely  local  significance.  He  believes 
that  drainage  and  the  correction  of  the  pathologic 
conditions  in  the  colon  can,  in  the  majority  of  cases, 
be  accomplished  by  the  technic  here  considered. 


Fig.  7. — Membranous  mass  removed  from  a diverticulum,  showing  a 
heavy  growth  of  staphylococcus,  from  a case  of  coloptosis  with 
large  dilated  cecum.  This  patient  had  suffered  for  ten  years  from 
dermatitis  herpetiformis  of  the  entire  body,  all  evidences  of  which 
disappeared  after  three  months’  treatment  of  the  colon. 


COLONIC  PATHOLOGY  AND  SYSTEMIC  INFECTION  >73 


To  quote  Dr.  Stokes’  own  words:  “The  patients 
are  given  a general  overhauling,  their  hygiene  is 
investigated  and  corrected,  if  possible.  . . . Many 
show  evidence  of  endocrine  imbalance,  others  are 
mildly  toxic,  and  frequently  the  colon  is  at  fault. 
These  cases  are  referred  to  Schellberg  for  cecal 
irrigation  and  the  establishment  of  proper  drain- 
age in  the  digestive  tract.”  22 

Since  1918,  Dr.  Stokes  has  given  special  atten- 
tion to  endocrine  depletion  due  to  influenza  as 
affecting  the  suprarenal  and  pituitary  glands. 

By  thoroughly  cleansing  the  entire  length  of  the 
colon  with  large  quantities  of  medicated  fluid 
which  are  quickly  absorbed  into  the  blood  stream, 
the  secretory  organs,  the  liver  in  particular,  are 
flooded,  and  the  kidneys  thoroughly  washed  out, 
the  entire  blood  stream  being  in  this  way  freed  of 
its  impurities.  No  matter  what  form  of  medica- 
tion or  other  therapy  be  employed  with  the  inten- 
tion of  combating  the  conditions  which  have  arisen 
because  of  the  infection  due  to  colonic  stasis,  until 
the  local  conditions  in  the  intestines  have  been  cor- 
rected, all  such  efforts  can  be,  at  best,  but  partially 
effective,  and  usually  they  will  fail  completely. 
In  many  instances  the  removal  of  the  infective 
focus  will  be  followed  by  immediate  disappearance 
of  the  remote  symptoms,  making  any  future  treat- 
ment wholly  unnecessary.  Not  only  is  the  estab- 
lishment of  proper  systemic  drainage  valuable  in 


74 


COLONIC  THEBAPY 


cases  of  manifest  disease,  but  careful  attention  to 
this  matter  will  always  greatly  raise  the  health 
standard,  even  of  those  who  do  not  look  upon 
themselves  as  sick,  and  in  considering  preventive 
medicine,  it  is  certainly  fully  as  important  to  make 
a careful  study  of  colonic  conditions  as  it  is  to  ex- 
amine the  state  of  the  teeth.  Upon  proper  elimi- 
nation of  waste  and  toxic  products  depend  the 
health  and  correct  function  of  every  gland  and 
organ  in  the  body. 

Of  the  many  methods  employed  to  restore  nor- 
mal intestinal  activity  and  function,  none  has 
proved  so  satisfactory  and  effectual  as  colonic  irri- 
gation. The  introduction  of  a warm  (50°  C.)  so- 
lution into  the  bowel  “hastens  the  rate  of  rhythmic 
contraction,”  as  has  been  shown  by  Magnus,  Tay- 
lor and  Alvarez ; 23  and  it  has  been  my  experience 
that  it  not  only  stimulates  active  downward  peri- 
stalsis in  the  entire  colon,  but  that  in  some  patients 
even  the  waves  of  the  ileum  are  made  stronger. 
Concerning  this  peristaltic  action  Alvarez  says: 
“The  gastrointestinal  tract  is  largely  autonomous, 
that  is,  it  carries  within  itself  the  mechanism  essen- 
tial to  peristalsis.  This  point  cannot  be  emphasized 
too  strongly,  because  it  seems  to  me  that  the  fail- 
ure to  grasp  it  is  the  greatest  stumbling-block  to 
further  advance  in  our  understanding  of  the  sub- 
ject. It  is  undoubtedly  true  that  the  extrinsic 
nerves  have  much  to  do  with  peristalsis,  but  it  is 


COLONIC  PATHOLOGY  AND  SYSTEMIC  INFECTION  75 

very  helpful  in  simplifying  our  problems  to  recog- 
nize that  the  tract  can  get  along  without  any 
outside  help  or  interference.  This  should  make  us 
the  more  willing  and  eager  to  study  the  all- 
important  local  mechanisms.”  15 

To  put  this  “local  mechanism”  in  proper  work- 
ing order  and  to  keep  it  so,  without  the  interfer- 
ence of  outside  agents  in  the  form  of  drugs,  is  the 
aim  of  proper  colonic  irrigation.  Heretofore  it 
was  commonly  supposed  that  a sufficiently  heavy 
catharsis  would  effectually  clear  out  the  intestinal 
canal,  but  I have  repeatedly  demonstrated  the 
fallacy  of  such  a conception.  After  the  adminis- 
tration of  four  ounces  of  castor  oil — the  patient 
being  on  “starvation  diet”  during  these  experi- 
ments— and  the  administration  of  a compound 
cathartic  pill  nightly,  large  quantities  of  residue 
have  been  removed  daily  by  successive,  colonic 
irrigations ; and  even  after  the  lapse  of  eight  days, 
when  the  patient  had  taken  one  and  a half  ounces 
of  castor  oil,  with  three  compound  cathartic  pills, 
followed  by  six  ounces  of  citrate  of  magnesia, 
colonic  irrigation  brought  away  more  residue  than 
had  been  evacuated  following  the  initial  dose  of 
castor  oil.  Where  colonic  stasis  exists  it  is  evident 
that  catharsis  is  wholly  inadequate  to  establish  or 
maintain  efficient  drainage. 

The  idea  that  the  taking  of  cathartics  or  enemas 
is  likely  to  induce  the  formation  of  a habit  is  not 


76 


COLONIC  THERAPY 


consistent  but  it  is  well  established  that  they  may 
be  injurious,  depending  upon  the  drug  ingested, 
or  the  method  of  taking  the  enema.  The  steady 
use  of  Epsom  salts,  or  related  substances,  produces 
inflammatory  conditions.  The  action  begins  in  the 
stomach,  causing  a violent  stimulation  of  the  ileum 
whereby  a large  amount  of  fluid  is  hastened 
through  the  colon  by  an  active  functioning  of  the 
cecum.  No  active  peristaltic  action  of  the  colon  is 
produced,  however,  and  the  liquid  is  quickly  ex- 
pelled by  the  rectum  because  of  its  active  disten- 
tion by  the  fluid.  But  when  it  is  desired  to  produce 
this  action,  as  in  certain  acute  conditions,  the  use 
of  Epsom  salts  may  be  justified. 

Any  interference  with  colonic  drainage  will  lead 
to  intestinal  disturbances  of  some  kind,  so  that  it 
is  obvious  that  the  maintenance  of  proper  drainage 
is  a matter  of  the  very  first  importance.  As  bac- 
teria colonize  in  the  colon  much  as  they  do  on  an 
agar  plate,  any  putrefactive  focus  of  bacterial  in- 
fection may  be  a determining  factor  in  the  produc- 
tion of  systemic  ailments. 

The  belief  that  cathartics  drain  the  system  is 
wholly  erroneous.  The  fluid  is  hastened  through 
the  alimentary  canal  before  absorption  can  take 
place  and  the  body  is  thus  robbed  of  necessaiy 
fluids.  Therefore,  following  the  use  of  cathartics 
we  find  urine  of  high  specific  gravity,  and  voided 
in  reduced  quantity.  This  condition  may  be  offset 


Fig.  !). — Membrane  and  feces  removed  from  a large  pocket  in  the  transverse  colon  after  antiseptic  treatment  and  the 

application  of  ichthyol. 


COLONIC  PATHOLOGY  AND  SYSTEMIC  INFECTION  77 

by  irrigations  of  the  colon  in  connection  with  ca- 
thartics, as  following  irrigations  a great  amount 
of  fluid  is  absorbed  by  this  organ.  This  augments 
the  volume  of  the  urine,  and  immediately  after 
irrigation  the  fulness  of  the  pulse  will  indicate  the 
increase  of  fluid  in  the  circulation. 

There  is  probably  no  part  of  the  body  which  re- 
quires more  care  and  attention  than  the  colon; 
and  it  is  equally  probable  that  no  other  part  of 
the  body  has  been  so  uniformly  neglected.  More 
than  that,  very  eminent  authorities,  the  most  con- 
spicuous perhaps  being  Sir  Arbuthnot  Lane,  have 
declared  that  the  colon  is  superfluous,  an  outgrown 
organ  existing  only  to  give  trouble;  the  utter  ex- 
tirpation of  which  can  only  result  in  benefit  to  him 
who  loses  it. 

There  remain,  however,  some  who,  having  given 
considerable  attention  to  the  matter,  still  believe 
that  the  colon  may  be  “reformed,”  and  with  proper 
care  and  treatment  returned  to  its  original  condi- 
tion of  harmlessness  and  efficiency.  Although 
many  diseases  undoubtedly  have  their  origin  in  the 
colon,  this  does  not  argue  that  it  is  a superfluous 
organ,  but  rather  that  we  have  misused  and  neg- 
lected it,  overlooking  entirely  its  great  importance 
in  the  human  economy.  The  generation  of  bac- 
terial poisons  in  the  digestive  tract,  and  their 
absorption  into  the  blood  stream  or  the  genito- 
urinary system  give  rise  to  a long  train  of  ills. 


78 


COLONIC  THERAPY 


If  we  can  devise  a means  of  emptying  out  this 
bacterial  incubator,  and  keeping  it  thereafter  free 
from  infection,  we  shall  have  gone  a long  way 
toward  “reforming”  the  colon. 

Certain  putrefactive  microorganisms  cause  an 
exudate  upon  the  intestinal  wall,  forming  what  I 
have  termed  intestinal  interlining  adhesions.  The 
matrix  of  some  of  these  adhesions  is  made  up  of 
fibrin,  in  which  numerous  small  round  cells  can  be 
observed  together  with  a few  polynuclears,  which, 
when  stained,  are  frequently  found  to  contain 
streptococci  and  staphylococci  in  almost  pure  cul- 
ture. These  adhesions  can  also  be  produced  by 
other  infectious  bacteria  in  a great  variety  of  com- 
binations, displaying  a more  or  less  pronounced 
matrix;  in  the  more  pronounced  forms  strips  of 
fibrin  enmeshing  red  blood-cells  and  desquamated 
epithelium  are  to  be  seen.  In  the  formation  of 
abdominal  adhesions  the  peritoneal  and  intestinal 
fluids  consist  of  both  exudate  and  transudate, 
solidifying  as  a protective  element,  on  the  inner, 
as  well  as  on  the  outer  wall  of  the  lumen,  an  in- 
flammatory process  being  the  causative  factor. 
This  fluid  is  rich  in  proteins  which  invite  the 
growth  of  cells  and  fibrin.  Thus,  living  elements 
are  produced  out  of  parts  previously  destitute  of 
shape. 

Descriptions  of  these  bowel  casts  are  not  com- 
monly found  in  literature,  so  the  following  excerpt 


COLONIC  PATHOLOGY  AND  SYSTEMIC  INFECTION  79 

from  P.  J.  Cammidge’s  Faeces  of  Children  and 
Adults  is  of  interest  in  this  connection: 

“Casts  of  the  Bowel. — More  or  less  complete 
casts  of  the  bowel  are  sometimes  passed.  These 
usually  consist  of  mucus,  but  occasionally  are 
‘diphtheritic’  membranes.  The  former  may  be 
mere  shreds  of  mucin-like  material  or  cylindrical 
masses,  varying  in  length  from  1 or  2 in.  up  to 
8 or  10  ft.  and  of  different  degrees  of  density. 
Even  in  children,  casts  18  or  20  in.  long  are  some- 
times met  with.  Such  casts  usually  have  a con- 
stant diameter  throughout  their  entire  length. 
They  are  generally  grey  in  color,  but  may  be 
translucent  or  even  transparent.  On  their  free 
surface  they  are  seen  to  be  studded  with  fine  white 
granules,  and  when  associated  with  an  acute  in- 
flammatory process,  may  be  studded  with  blood. 
They  are  frequently  passed  with  severe  tenesmus, 
without  any  associated  faecal  material.  Mucus 
casts  are  met  with  in  both  acute  and  chronic  in- 
flammations of  the  mucosa  of  the  large  intestine, 
the  intensity  of  the  lesion  being  indicated  by  the 
number  of  entangled  epithelial  cells.  The  long, 
thin  tubular,  or  tape-like  membranes  passed  in 
muco-membranous  colitis  have  been  ascribed  to 
absorption  of  water  and  the  astringent  action  of 
the  faeces  on  the  mucus  which  accumulates  round 
them  when  they  are  retained  for  several  days;  but 
more  probably  they  arise  from  the  action  of  a spe- 


80 


COLONIC  THERAPY 


cial  mucus-coagulating  ferment  secreted  by  the 
mucous  membrane.  Casts  which  do  not  present 
a membranous  formation  until  they  have  been 
carefully  suspended  in  water  may  also  be  passed 
with  a good  deal  of  tensemus  and  the  absence  of 
faecal  material  in  mucous  colitis,  and  are  not  un- 
common in  gastroptosis  and  in  enteroptosis.”  21 

Generally,  in  slight  intestinal  perforations 
where  there  is  a focus  of  infection  within  the  in- 
testine, adhesions  are  likely  to  be  produced.  Nat- 
urally, we  should  assume  that  the  production  of 
intestinal  and  peritoneal  fluids  is  a part  of  nature’s 
process  of  checking  general  leakage  from  the 
lumen,  acting  in  a manner  similar  to  clot -forma- 
tions in  leakage  of  the  blood-vessels.  Extensive 
intestinal  adhesions  are  found  in  cases  of  perico- 
litis. 

Ordinarily,  we  encounter  extensive  adhesions  in 
the  vicinity  of  the  cecum,  the  hepatic  and  splenic 
flexures  and  the  pelvic  loop.  It  is  also  at  these 
points  that  drainage  is  most  likely  to  be  obstructed. 
However,  to  attempt  to  classify  the  nondrain- 
able  points  of  the  colon  would  be  a difficult  task, 
as  adhesions  in  one  part  of  the  colon,  aided  by 
angulations  or  chronic  spasms  due  to  foci  of  infec- 
tion, may  distort  this  organ  into  all  sorts  of  shapes, 
producing  pockets  of  various  dimensions,  as  well 
as  constrictions  which  may  cause  serious  strangula- 
tions. Case,24  who  has  done  extensive  x-ray  work 


Pig.  10.— Specimen  from  the  same  case  as  rig.  0,  following  t 
bulgaricus.  Note  the  breaking  down  of  the  membrane. 


COLONIC  PATHOLOGY  AND  SYSTEMIC  INFECTION  81 

on  colon  abnormalities  and  diseases,  is  authority 
for  the  statement  that  one  may  deduce  from  the 
work  of  Eastman,  Hertzler  and  Jackson— in  par- 
ticular the  latter — the  fact,  that  even  when  we  are 
able  to  elicit  no  history  pointing  to  the  existence 
of  any  previous  intestinal  inflammation  it  is  pos- 
sible for  extensive  colonic  adhesions  to  exist  as  a 
result  of  chronic  intestinal  stasis.  He  adds  also 
that  “patients  with  colonic  adhesions  are  much  to 
be  pitied  because  the  adhesions  are  often  not 
recognized.” 

Any  increase  of  pressure  within  the  bowel,  any 
weakening  of  the  muscular  tone  of  the  wall  as  a 
whole,  in  fact,  whatever  causes  may  act  to  weaken 
the  wall  at  any  point,  will  offer  opportunity  for 
hernial  protrusion,  and  give  rise  to  diverticula  or 
sacculi.  Given  a series  of  pockets  resulting  from 
relative  weakness  of  the  bowel  wall  and  containing 
fecal  material  and  possibly  foreign  bodies,  we  can 
quite  easily  predict  the  various  lines  of  pathologic 
development  which  these  diverticula  will  be  likely 
to  follow.  There  are  two  aspects  to  be  reckoned 
with,  the  mechanical  factor  and  the  pathologic  or 
toxic  element.  Any  fecal  mass  not  periodically 
expelled  will  tend  to  inspissate,  and  will  likewise 
become  a nidus  for  bacterial  flora  of  varying  sepsis 
and  virulence,  and  this,  combined  with  the  me- 
chanical rotation  of  the  concretions,  will  almost 
invariably  bring  about  some  sort  of  inflammatory 


82 


COLONIC  THERAPY 


reaction.  So  we  might  expect  to  find  fibrous 
hyperplasia  with  the  usual  result,  contraction  of 
newly  formed  tissue.  If  the  organisms  present  are 
very  virulent  we  are  likely  to  get  an  acute  inflam- 
mation, or  ulcerations,  and  even  gangrene  may 
occur.  In  milder  cases  we  should  be  likely  to  find 
ulcerations  resulting  in  chronic  local  abscess 
formation,  a process  of  which  adhesions  are  an 
invariable  sequel.25 

Incomplete  and  infrequent  evacuations  of  the 
bowel  may  be  caused  by  diverticula  or  an  increase 
in  the  size  of  the  normal  sacculi  of  the  colon.  If 
these  sacs  are  deep  enough,  feces  may  accumulate 
in  them  and  their  passage  be  seriously  delayed  or 
altogether  prevented.  A state  of  chronic  costive- 
ness may  result  from  the  collection  of  a large 
amount  of  residue  in  such  a cul-de-sac,  for  peri- 
stalsis will  be  very  greatly  impeded,  and  even 
obstruction  produced,  while  the  entire  bowel  maj^ 
be  dragged  downward,  resulting  in  enteroptosis 
and  angulations,  or  even  producing  enterospasms. 
All  this  will  increase  obstacles  in  the  passage  of 
the  fecal  current  through  the  affected  part  of  the 
bowel.  If  these  pockets  are  large  and  narrow  the 
action  is  much  like  that  of  adhesions  in  the  form 
of  bands  so  that  they  may  cause  obstruction  by 
direct  pressure  upon  the  intestine,  or  a greater  or 
less  degree  of  strangulation.  Hernia  of  the  mu- 
cosa may  form  in  different  parts  of  the  bowel  by 


COLONIC  PATHOLOGY  AND  SYSTEMIC  INFECTION  83 

the  giving  way  of  the  mucosa  coat,  thus  diminish- 
ing the  walls’  propulsive  power  and  favoring  im- 
pactions, until  a decided  bulging  will  take  place 
at  the  affected  spot.  These  sacculi  are  most  often 
found  in  the  sections  of  the  colon  where  there  is 
likely  to  be  sagging,  as  in  the  cecum,  the  transverse 
colon  and  the  sigmoid  flexure.26 

The  victims  of  diverticula  are  often — in  fact 
usually — obese,  because  in  such  patients  there  is 
apt  to  be  excessive  development  of  the  appendices 
epiploicae,  and  also  of  fat  under  the  serous  coat 
of  the  intestine  which  diminishes  the  resistance  of 
the  wall  to  any  extra  pressure  which  may  happen 
to  be  exerted.  These  pockets  are  for  the  same  rea- 
son much  less  frequent  in  young  subjects.27 

According  to  Pfahler,28  constrictions  of  the 
colon  are  most  likely  to  be  found  at  the  hepatic, 
splenic  and  sigmoid  flexures,  but  they  may  occur 
anywhere.  Carcinoma  is  especially  apt  to  be  lo- 
cated at  the  sigmoid  flexure,  in  the  cecum  and  in 
the  rectum,  and  when  present  is  usually  limited  in 
the  early  stage  to  a comparatively  small  area.  The 
initial  symptoms  of  carcinoma  are  often  over- 
looked. In  the  absence  of  hemorrhoids  or  benign 
rectal  lesions  the  passage  of  a slight  amount  of 
bloody  mucus  should  always  be  regarded  as  a 
danger  signal.  When  there  is  any  suspicion  of 
malignancy,  all  measures  to  clean  the  bowel  should 
be  pursued  with  the  utmost  caution,  and  the  exact 


84 


COLONIC  THERAPY 


condition  be  previously  made  as  clear  as  possible  by 
x-ray  examination. 

While  I do  not  wish  to  deprecate  the  value  of 
roentgenographs  of  the  colon,  they  not  infre- 
quently remind  me  of  the  silhouettes  which  ante- 
dated the  era  of  photography.  While  an  x-ray  of 
the  colon  filled  by  a barium  meal  gives  the  outline 
and  anatomical  position  of  the  organ,  it  shows  none 
of  the  defects  due  to  the  presence  of  gas  and  feces, 
so  that  such  an  outline  is  less  exact  than  the  clear- 
cut  delineation  of  the  old-time  silhouette. 

Disease  may  exist  in  the  colon  and  yet  remain 
unrevealed  by  fluoroscope  or  roentgenograph. 
The  x-ray  photograph  of  the  colon  filled  with  a 
barium  meal  does  not  give  a comprehensive  picture 
of  the  state  of  the  colon,  for  it  is  possible  for  a 
diverticulum  to  exist  on  the  side  opposite  to  that 
facing  the  roentgenographer,  though  all  that 
would  appear  in  the  roentgenograph  would  be  a 
smooth  black  surface  like  the  silhouette.  A sil- 
houette profile  gives  no  intimation  that  its  subject 
possesses  ears. 


CHAPTER  V 


THE  FUTILE  ENEMA 

Establishment  of  free  colonic  drainage  necessary  to  health 
— Effects  of  intra-abdominal  pressure — Futility  of  the  enema 
as  usually  administered — Hot  solutions  wholly  ineffective 
without  preliminary  emptying  of  the  colon — Effect  of  method 
of  irrigation  without  special  apparatus — Proper  irrigative 
treatment  does  not  produce  shock,  but  stimulation — Consist- 
ent, continued  irrigation  only  is  effective — Roentgenologic 
diagnosis  of  diseased  conditions  that  have  been  effectually 
relieved  by  properly  applied  irrigation. 


CHAPTER  V 


THE  FUTILE  ENEMA 

Establishment  of  free  colonic  drainage  necessary  to  health 
— Effects  of  intra-abdominal  pressure — Futility  of  the  enema 
as  usually  administered — Hot  solutions  wholly  ineffective 
without  preliminary  emptying  of  the  colon— Effect  of  method 
of  irrigation  without  special  apparatus — Proper  irrigative 
treatment  does  not  produce  shock,  but  stimulation — Consist- 
ent, continued  irrigation  only  is  effective— Roentgenologic 
diagnoses  of  diseased  conditions  that  have  been  effectually 
relieved  by  properly  applied  irrigation. 


Any  attempt  to  clear  out  the  lower  part  of  the 
digestive  canal  must  presuppose  a complete  knowl- 
edge of  the  anatomy,  physiology,  and  pathology, 
not  only  of  the  parts  which  are  directly  involved, 
but  also  of  the  entire  abdominal  region;  and,  in 
addition  to  this  knowledge,  one  must  also  be  pos- 
sessed of  a thorough  comprehension  of  the  chemi- 
cal reaction  of  any  solution  or  therapeutic  measure 
to  be  employed.  Even  when  all  this  has  been  fully 
acquired,  it  is  still  necessary  to  master  the  opera- 
tive technic  and  to  become  possessed  of  a skill  and 
manual  dexterity  which  only  results  from  long  and 

varied  experience.  It  is  my  purpose  here  to  de- 

87 


88 


COLONIC  THERAPY 


scribe  a technic  for  colon  irrigation  designed  to 
meet  the  needs  I have  outlined  in  the  foregoing 
chapters,  and  to  explain  the  steps  by  which  the 
colon — even  when  badly  diseased — may  be  re- 
stored to  normal  function  and  vigor.  For  the 
removal  of  many  abnormalities  of  the  colon  this 
method  will  be  found  simpler  and  safer  than 
surgery.29 

In  a diseased  excretive  organ  it  is  not  always 
the  disease  that  is  fatal;  often  it  is  the  inability  of 
the  organ  to  carry  on  its  function  in  a normal  way, 
which  results  in  the  absorption  into  the  body  of 
those  substances  which  should  be  expelled.  This 
is  well  illustrated  in  the  study  of  urinary  metab- 
olites, where  death  soon  follows  the  inability  of 
the  kidneys  to  perform  their  excretory  functions. 
The  failure  of  intestinal  excretion  is  not  so  imme- 
diately fatal,  because  of  the  existence  of  the  func- 
tional drainage  of  the  kidneys,  skin  and  lungs,  but 
the  accompanying  metabolic  disturbances  are 
equally  disastrous.  To  combat  disease  success- 
fully, the  process  of  tissue  change  whereby  the 
function  of  nutrition  is  effected,  must  not  be  over- 
balanced by  the  concurrent  breaking-down  proc- 
esses— anabolism  must  not  be  overwhelmed  by 
catabolism.  To  preserve  this  proper  balance 
we  must  often  resort  to  artificial  elimination. 
It  is  my  experience  that  many  diseases  usually 
considered  chronic  and  fatal  can  be  arrested, 


THE  FUTILE  ENEMA 


89 


if  not  entirely  cured,  by  artificial  drainage.  I 
trust  I may  be  pardoned  for  inserting  here  a 
statement  offering  confirmation  of  my  point  of 
view,  which  was  published  several  years  ago  by  one 
whose  experience  and  standing  in  the  medical  pro- 
fession lend  prestige  to  his  opinions : 

“Schellberg  has  cured  many  very  obstinate  cases 
of  intestinal  infection  and  ailments  resulting  from 
the  absorption  of  bacterial  toxins.  He  has  demon- 
strated conclusively  the  practical  value  of  the  long 
rectal  tube  for  irrigation  and  cleansing  the  large 
intestine.  X-ray  photographs  show  clearly  that 
such  a tube  may  be  passed  through  the  colon  as  far 
as  the  cecum.  We,  as  medical  men,  know  that  a 
large  number  of  chronic  pathological  conditions 
are  traceable  to  the  absorption  of  putrefactive 
elements  from  the  colon.  These  putrefactive  ele- 
ments are  either  bacterial  toxins  themselves  or  are 
formed  by  the  action  of  bacteria  on  proteid  matter 
held  in  the  colon.”  30 

Not  alone  can  the  colon  be  aided  by  irrigating 
its  entire  length;  the  effects  of  such  irrigation  ex- 
tend to  the  ileum,  the  jejunum,  the  duodenum,  the 
stomach,  and  even  the  throat.  We  do  not  need  to 
stop  at  these;  we  can  include  the  ductless  glands, 
the  heart,  the  blood-vessels,  the  lungs  and  the  skin. 
In  other  words,  we  can  include  the  entire  body; 
and,  I may  add,  in  successfully  combating  any  dis- 
ease the  alimentary  canal  is  the  most  effective  point 


90 


COLONIC  THERAPY 


of  attack.  I do  not  refer  to  the  use  of  the  soap- 
suds or  saline  enema,  or  to  the  method  of  irrigation 
that  is  commonly  prescribed  and  followed  in  homes 
and  institutions  by  inexperienced  persons.  Any- 
one who  prescribes  such  irrigations  and  expects 
any  satisfactory  or  effective  results  is  not  possessed 
of  a thorough  knowledge  of  the  anatomy,  physi- 
ology and  pathology  of  the  human  intestinal  tube. 
There  is  no  danger  in  irrigating  a colon  with  a 
suitable  rectal  tube  and  equipment,  if  the  instru- 
ments are  handled  with  sufficient  skill.  But  there 
is  danger  of  injury,  or  even  death,  if  the  technic 
employed  is  faulty  and  the  proper  implements  are 
lacking.  Often,  in  a gastro-enteroptosis  or  other 
defect  of  the  canal,  the  method  used  is  to  place  the 
patient  in  the  knee-chest  position,  thus  causing  the 
visceral  organs  to  drop  forward,  and  forcing  the 
feces  and  gas  out  of  the  rectum  and  sigmoid  up 
into  the  colon  and  ileum;  then  setting  the  patient 
upon  a commode  or  having  him  walk  to  a toilet, 
with  his  abdomen  distended  with  solution  and  the 
intestines  dropping  down,  locking  the  gas  and 
feces  within  the  tube.  Such  treatment  has  often 
caused  excruciating  pain,  collapse  and  death. 

Hamburger’s  investigations  have  thoroughly 
explained  the  influence  of  intra-abdominal  pres- 
sure on  absorption,  and  the  question  of  blood  pres- 
sure was  also  considered.  He  increased  intra- 
abdominal  pressure  by  injecting  physiologic  saline 


THE  FUTILE  ENEMA 


91 


solution,  and  attempted  to  eliminate  the  elasticity 
of  the  abdominal  wall  by  placing  a plaster-of- 
Paris  cast  around  the  abdomen  of  a rabbit.  At  the 
beginning  of  the  increase  of  intra-abdominal  pres- 
sure he  observed  a rise  of  blood  pressure,  but  when 
intra-abdominal  pressure  reached  a high  level  there 
was  a sudden  fall  in  blood  pressure  followed  by  the 
death  of  the  animal.  It  is  known  also  that  death 
may  be  brought  about  by  an  isolated  loop  in  the 
lumen  of  the  gut;  so  we  can  readily  understand 
how  injury,  suffering,  and  death  may  follow  from 
many  specific  causes.  The  introduction  of  a large 
amount  of  fluid  into  the  lumen  of  the  intestine 
when  there  is  malformation  of  the  tube,  or  even 
where  a spastic  condition  exists,  will  form  a large 
tumor  with  the  increase  of  intestinal  exudate  and 
gases  which  are  bound  to  follow  in  an  isolated  sec- 
tion of  the  lumen.  When  pressure  is  exerted  in 
the  abdominal  cavity,  the  circulation,  especially 
that  in  the  veins,  labors  against  increased  re- 
sistance, and  if  the  pressure  against  the  larger 
veins  is  severe  enough  the  heart  will  fail  because 
it  contains  no  more  blood  upon  which  to  act.  This 
is  only  one  of  the  fatal  injuries  which  may  occur 
from  increased  intra-abdominal  pressure. 

Another  ineffective  method  is  the  use  of  two 
rectal  tubes.  Why  try  to  pass  two  tubes,  when  it 
is  so  difficult  to  pass  one?  This  method  is  no  more 
effective  than  an  enema.  The  rectum,  only,  is 


92 


COLONIC  THEEAPY 


irrigated ; and  the  patient  is  caused  a great  deal  of 
discomfort.  The  ordinary  method  of  irrigation 
employed  does  one  of  two  things  or  sometimes 
both.  It  merely  washes  the  feces  out  of  the  rec- 
tum, or  by  overdistention  from  the  liquid  forces 
them  back  into  the  colon — sometimes  as  far  as  the 
cecum.  A very  able  physician,  well  versed  in  the 
anatomy  and  pathology7  of  the  colon,  once  inquired 
of  a head  nurse  in  a certain  hospital: 

“What  is  your  technic  of  a ‘low  irrigation,’  and 
technic  of  a ‘high  irrigation,’  that  you  mention?” 

“Why,  doctor,”  replied  the  nurse,  beaming  with 
confidence,  “in  a low  irrigation,  the  douche-bag  is 
held  fifteen  inches  above  the  patient,  and  in  a high 
irrigation  the  douche-bag  is  held  three  feet  above 
the  patient.” 

Are  we  to  condemn  the  nurse  for  her  lack  of 
knowledge,  or  should  we  condemn  those  who  should 
have  taught  her  better?  We  should  condemn  those 
who  have  written  text-books,  and  put  themselves 
on  record,  without  having  any  more  real  knowl- 
edge of  the  colon,  and  the  proper  technic  of  its 
treatment  than  did  this  nurse.  How  many  times 
has  a “high,  hot  colon”  irrigation  been  ordered? 
And  how  many  times  has  a nurse  or  an  orderly 
attempted  to  carry  out  the  physician’s  order  with 
a rectal  tube  about  fifteen  inches  long,  that  would 
bend  on  itself  if  it  met  with  the  slightest  resistance, 
proceeding  to  put  a hot  solution  into  the  intestine. 


THE  FUTILE  ENEMA 


93 


without  having  the  slightest  knowledge  of  colon 
physiology?  The  results  of  such  treatment  are 
written  thousands  of  times  upon  hospital  charts: 
“High,  hot  colon;  no  result.”  The  physician’s 
order  to  give  the  enema;  the  nurse’s  attempt  to 
carry  out  his  orders ; the  instrument  with  which  she 
was  provided  and  the  hot  solution  she  tried  to  put 
into  the  colon  are  all  utterly  futile.  Hot  solution 
in  quantities  amounting  to  over  a few  ounces 
cannot  reach  the  colon,  unless  it  has  been  cleared 
beforehand,  as  the  solution  will  all  be  expelled  by 
the  rectum.  The  rectum’s  normal  function  is  to 
expel  any  such  solution  immediately;  and  with 
such  a tube  as  that  with  which  the  nurse  is  supplied 
it  is  impossible  to  reach  the  pelvic  colon.  One  is 
amazed  to  read  the  assertions  of  certain  investiga- 
tors armed  with  x-ray  equipment,  who  imagine 
they  have  proved  to  the  world  that  a rectal  tube 
cannot  be  passed  beyond  the  sigmoid  flexure. 
Truly,  we  need  no  x-ray  to  prove  that  such  a tube 
coils  on  itself  when  introduced  into  the  rectum; 
it  requires  but  a limited  amount  of  reasoning  to 
realize  that  such  a small,  flexible  tube  cannot  be 
passed.  Nevertheless  a proper  rectal  tube  can  be 
passed  into  the  colon  without  difficulty  by  those 
who  possess  the  essential  skill,  and  are  thoroughly 
conversant  with  the  anatomy  of  the  parts. 

When  the  proper  equipment  to  irrigate  a colon 
is  not  at  hand,  instead  of  using  an  ineffective  colon 


94 


COLONIC  THERAPY 


tube,  the  patient  should  be  placed  on  the  left  side, 
and  a douche-bag  with  an  ordinary  hard-rubber  tip 
pressed  into  service.  Introduce  a pint  or  two  of 
solution  at  37°  C.;  allow  the  patient  to  expel  im- 
mediately; and  clean  the  rectum  of  feces  and  gas; 
thereafter  allowing  the  patient  to  rest  for  a half 
hour  or  an  hour.  This  should  be  followed  with 
another  enema  of  a larger  amount  of  solution, 
keeping  the  patient  always  on  the  left  side.  By 
this  simple  process  the  rectum  will  be  relieved — 
and  no  doubt,  the  sigmoid  also — of  feces  and  gas, 
and  the  vermiform  muscles  will  be  stimulated  to 
exert  traction  and  further  empty  the  bowel. 

This  can  be  done  readily  as  often  as  is  necessary 
without  causing  any  ill  effects  whatever.  I have 
frequently  heard  it  said  that  a patient  was  “too 
weak  to  be  irrigated.”  A proper  irrigation  is  not 
a shock,  nor  does  it  have  any  tendency  to  weaken. 
Why  should  it?  On  the  contrary,  it  is  stimulat- 
ing; but  to  use  a high-temperature  solution  in  the 
colon  of  a patient  who  is  suffering  from  an  eleva- 
tion of  blood  pressure  or  a cardiac  defect  is  a 
dangerous  procedure.  In  the  same  case,  however, 
if  the  proper  precautions  are  taken  and  a normal 
temperature  solution  employed,  there  is  no  danger 
other  than  that  of  adding  a little  more  fluid  to  the 
blood  stream. 

The  soapsuds  enema  stimulates  peristalsis,  and 
also  supplies  a lubricant,  but  it  has  no  value  as  a 


THE  FUTILE  ENEMA  95 

curative  measure.  An  enema  of  normal  saline 
solution  does  not  even  possess  any  of  these  quali- 
ties, nor  is  it  as  efficient  in  liquefying  feces  as  is 
soapsuds.  Glycerin  is  an  irritant  to  the  mucous 
membrane.  Olive  oil  is  of  no  value  whatsoever; 
it  is  given  as  an  emulsifier  but  actually  it  does  not 
possess  even  this  action.  I have  placed  a piece  of 
feces  in  a test-tube  containing  olive  oil,  and  seen 
it  retain  its  form  for  several  days;  the  same  feces 
in  sterile  water  was  softened  within  half  an  hour; 
with  a solution  of  sodium  carbonate  it  was  dis- 
solved more  thoroughly,  as  was  also  the  case  with 
a solution  of  sodium  phosphate ; and  a 20  per  cent, 
solution  of  hydrogen  peroxid  became  active  at 
once. 

What  anyone  can  expect  to  accomplish  by  the 
single  saline  solution  irrigation  once  a week  which 
is  so  many  times  prescribed,  I wholly  fail  to  under- 
stand, for  it  often  requires  many  successive  days 
of  daily  irrigation  with  efficient  medicated  solu- 
tions to  straighten  out  and  clean  a pelvic  colon 
which  is  impacted  with  feces  and  adherent  to  the 
pelvic  wall.  Frequently,  even  before  arriving  at 
the  splenic  flexure  when  making  the  turn  into  the 
transverse  colon,  a large  pocket  may  be  found 
which  contains  a great  quantity  of  offensive  and 
decomposed  feces  and  is  ulcerated  from  the  colon- 
ization of  putrefactive  organisms.  It  can  readily 


96 


COLONIC  THERAPY 


be  seen  how  ineffective  would  be  a saline  irrigation 
applied  without  a proper  rectal  tube,  when  given 
but  once  a week,  or  even  if  it  were  given  daily. 
Yet  such  a condition  is  only  one  of  thousands 
which  might  be  used  in  illustration. 

It  is  impossible  to  classify  the  multitude  of  de- 
fects to  which  the  visceral  organs  are  liable.  I will 
cite  a few  cases  where  the  pathologic  conditions 
have  been  adjusted,  and  the  patients  restored  to 
perfect  health  by  proper  daily  irrigations  with 
suitable  solutions  (elsewhere  described  in  detail), 
combined  with  adjustment  of  diet,  and  tonic  medi- 
cation prescribed  by  a competent  internist.  From 
one  to  six  years  have  elapsed  since  the  discharge 
of  these  patients. 

Case  I — X-ray  Diagnosis. 

No  gastric  delay  (atony). 

Duodenum  retracted  backward;  defect  on  anterior  surface; 
spasm  of  duodenum;  second  and  third  portions  dilated. 
Ulcer  of  duodenum. 

Adhesions  or  bands  involving  the  terminal  ileum  and  cecum, 
and  obstructing  the  drainage  of  these  structures.  Ex- 
cessive ileac  delay. 

Chronic  appendicitis ; inflammatory  extension  upward  to  the 
inner  side  of  the  terminal  ileum  (adhesions). 

Sigmoid  very  redundant,  consisting  of  several  loops. 

Bacterial  flora  of  the  colon. 

Bacillus  coli  (numerous). 

Bacillus  aerogenes  capsulatus  (numerous). 

Streptococci. 

Gram-positive  bacilli. 


THE  FUTILE  ENEMA 


97 


Case  II. 

Intestinal  toxemia. 

Indicanuria. 

Hypothyroidism. 

Flora. 

Bacillus  coll. 

Staphylococci  (few). 

Bacillus  aerogenes  capsulatus  (numerous). 
Gram-positive  bacilli. 

Case  III. 

General  splanchnoptosis. 

Dilated,  ptosed  myasthenic  stomach. 

Dilated  cecum  and  ascending  colon. 

Transverse  colon  ptosed  to  pelvic  floor. 

Ptosed  liver. 

Ptosed  right  kidney. 

Dilated,  dropped  duodenum. 

General  and  colonic  stasis. 

Flora. 

Bacillus  coli  (numerous) 

Staphylococci  (few). 

Bacillus  aerogenes  capsulatus  (numerous). 
Gram-positive  bacilli  (few). 

Case  IV. 

Indicanuria  three  plus. 

Intestinal  toxemia. 

Cholecystitis. 

Flora. 

Streptococci  (few). 

Bacillus  aerogenes  capsulatus  in  considerable  number. 
Bacillus  coli. 

Gram-positive  bacilli  and  diplococci. 


98 

Case  V. 


COLONIC  THERAPY 


Spastic  descending  colon. 

Spastic  sigmoid. 

Dilated  cecum. 

Congested  liver. 

Flora. 

Staphylococci  (numerous). 

Bacillus  coli  (numerous). 

Bacillus  aerogenes  capsulatus. 

Gram-positive  bacilli  and  diplococci  (few). 

Case  VI. 

Intestinal  toxemia. 

Spastic  anus. 

Atonic  constipation. 

Dilated  cecum. 

Inactive  liver  (bile  insufficiency). 

Hypotension. 

Flora. 

Staphylococci  (numerous). 

Bacillus  coli  and  Bacillus  aerogenes  capsulatus,  in  mod- 
erate number. 

Gram-positive  diplococci  and  bacilli  (few). 

Case  VII. 

Duodenal  regurgitation. 

Marked  indicanuria. 

Atonic  constipation. 

Dilated  hepatic  flexure  and  first  third  of  transverse  colon. 
Infected  (pus)  tonsil. 

Beginning  arteriosclerosis. 

Flora. 

An  occasional  streptococcus. 

Bacillus  coli. 


THE  FUTILE  ENEMA 


99 


Gram-positive  bacilli. 

Bacillus  aerogenes  capsulatus. 

Staphylococci  (few). 

Case  VIII. 

Intestinal  toxemia. 

Nervous  indigestion. 

Gastroenteroptosis. 

Right  nephroptosis. 

Flora. 

Bacillus  coli  (numerous). 

Staphylococci  (few). 

Bacillus  aerogenes  capsulatus  in  considerable  number. 
Gram-positive  bacilli  and  diplococci. 

Case  IX. 

Gastro-enteroptosis. 

Lower  end  of  pelvic  colon  adherent  to  rectum. 

Dilated  pelvic  colon. 

Angulation  of  splenic  flexure. 

Transverse  colon,  ascending  colon  and  cecum  dilated. 
Blood  pressure  240  (systolic). 

Flora. 

Bacillus  coli. 

Bacillus  aerogenes  capsulatus. 

Streptococci. 

Case  X. 

Spastic  rectum. 

Large  dilated  colon. 

Marked  meteorism. 

Flora. 

A saprophytic  organism. 

Bacillus  coli  (few). 


100 

Case  XI. 


COLONIC  THEEAPY 


Epilepsy,  grand  mal. 

Large  dilated  stomach. 

Retarded  gastric  motility. 

Large  dilated  cecum  and  terminal  ileum. 

Flora. 

Bacillus  coli  (numerous). 

Staphylococci  (few). 

An  occasional  streptococcus. 

Gram-positive  bacilli. 

Bacillus  aerogenes  capsulatus  (numerous). 

Case  XII. 

Gastro-enteroptosis. 

Asthenic  abdominal  wall. 

Prolapse  of  uterus. 

Infected  right  ovary. 

Flora. 

Bacillus  coli. 

Staphylococci. 

Bacillus  aerogenes  capsulatus  (few). 

Case  XIII. 

Asthma. 

Spastic  rectum  and  sigmoid. 

Angulation  of  the  splenic  and  hepatic  flexures. 
Pockets  in  transverse  colon. 

Large,  dilated  cecum. 

Feces  highly  offensive,  with  odor  of  sulphur. 
Flora. 

Streptococci. 

Staphylococci. 

Colon  bacilli. 


THE  FUTILE  ENEMA 


101 


Case  XIV. 

Hemorrhoids. 

Ptosed  rectum. 

Large  atonic  colon. 

Abnormally  large  cecum. 

Flora. 

Bacillus  colt. 

Staphylococci  (few). 

Bacillus  aerogenes  capsulatus. 

Gram-positive  bacilli. 

Case  XV. 

Marked  fecal  stasis. 

Coloptosis. 

Cecum  adherent  to  pelvic  floor. 

Flora. 

Streptococci. 

Staphylococci. 

Colon  bacilli. 

Case  XVI. 

Distended  abdomen. 

Marked  tympanites. 

Hemorrhoids. 

Large  bleeding  ulcer  of  pelvic  colon. 

Dilated  transverse  colon,  ascending  colon,  and 

Flora. 

Bacillus  coli  (numerous). 

Gram-positive  bacilli. 

Bacillus  aerogenes  capsulatus  (numerous). 
Staphylococci. 

(Blood  positive  to  benzidin). 


cecum. 


102 

Case  XVII. 


COLONIC  THERAPY 


Marked  gastro-enteroptosis. 

Ptosed  liver. 

Spastic  rectum,  marked  atony  of  colon  with  pockets. 
Hemoglobin — 40-50  per  cent. 

Flora. 

Bacillus  coli. 

Staphylococci  (few). 

An  occasional  streptococcus. 

Bacillus  aerogenes  capsulatus  (few). 

Gram-positive  bacilli. 


CHAPTER  VI 


TECHNIC  OF  COLONIC  IRRIGATION 

Local  medication  most  effective  in  the  colon — Necessity  of 
clearing  the  gut  before  applying  local  treatment — Description 
of  cecum  tube — Apparatus  for  irrigation — Formulas  for  irri- 
gating solutions — Purpose  of  the  different  solutions — Control 
of  intestinal  hemorrhage — Absorption  of  fluid — Coloptosis — 
Method  of  relief — Peristalsis  as  an  aid  in  emptying  the  im- 
pacted cecum — Position  of  patient  for  irrigation — Method  of 
advancing  the  tube. 


CHAPTER  VI 


TECHNIC  OF  COLONIC  IRRIGATION 

Local  medication  most  effective  in  the  colon — Necessity  of 
clearing  the  gut  before  applying  local  treatment— Description 
of  cecum  tube — Apparatus  for  irrigation — Formulas  for  irri- 
gating solutions — Purpose  of  the  different  solutions — Control 
of  intestinal  hemorrhage — Absorption  of  fluid — Coloptosis — 
Method  of  relief— Peristalsis  as  an  aid  in  emptying  the  im- 
pacted cecum — Position  of  patient  for  irrigation — Method  of 
advancing  the  tube. 


In  treating  the  defects  of  the  colon,  we  must 
bring  our  efforts  to  bear  directly,  using  both  me- 
chanical appliances  and  medicinal  agents.  This 
can  be  successfully  accomplished  through  the  rec- 
tum as,  when  the  solutions  are  applied  there,  they 
do  not  undergo  the  changes  that  take  place  in  sub- 
stances given  by  mouth.  Neither  do  they  disturb 
the  stomach  or  other  organs.  Actually  but  very 
few  chemicals,  when  administered  orally,  ever 
reach  the  colon  in  a curative  form.  I find  that 
antiseptics  and  other  medicaments  can  be  most 
effectively  applied  to  the  colon  through  the  rectum, 
thus  insuring  their  physiologic  action  without  gen- 
eral systemic  disturbance.  An  effective  treatment 

105 


106 


COLONIC  THEHAPY 


of  acidosis,  or  of  duodenal  and  gastric  ulcers,  etc., 
is  by  the  use  of  antiseptics  followed  by  four  to 
eight  ounces  of  sodium  phosphate  and  an  ounce  of 
sodium  salicylate  in  a quart  solution  (which  pro- 
duces a soft,  lubricating,  emulsifying  solution) 
applied  in  the  cecum.  This  can  be  given  daily 
without  any  disturbance  to  the  patient,  and  is  a 
most  useful  method  for  producing  general  stimula- 
tion of  the  excretory  tract. 

The  only  way  to  clean  an  intestinal  pocket,  or 
to  straighten  an  adherent  loop  in  the  colon,  is  by 
mechanical  and  antiseptic  measures.  For  such 
conditions,  my  most  important  instrument  is  a 
54-inch  cecum  tube  (50-French),  fitted  with  a 
pointed  tip,  shaped  somewhat  like  a gunnery  shell. 
This  tapering  point,  when  passed  slowly  into  the 
colon,  will  slip  off  such  folds  as  it  may  encounter, 
and  the  end  being  flexible,  it  is  enabled  to  bend 
around  sharp  angles,  while  the  body  of  the  tube, 
being  more  rigid,  makes  it  possible  to  lift  the  colon. 
Other  tubes  are  required,  as  we  must  have  both 
small  and  large,  and  these  must  also  be  soft  and 
flexible  so  as  to  prepare  the  way  for  the  stiff  cecum 
tube.  The  cecum  tube  is  rigid  when  new,  but  it 
becomes  soft  from  sterilization,  and,  where  a great 
number  are  used,  runs  a large  scale  in  flexibility. 

The  irrigator  consists  of  a swinging  crane,  a 
frame  constructed  to  hold  three  glass  tanks — one 


TECHNIC  OF  COLONIC  IRRIGATION  107 

three-gallon,  and  two  two-quart — a small  tank  for 
antiseptic  solution,  and  another  for  bacterial  cul- 
tures. Each  tank  is  equipped  with  a cover  and 
with  electric  bulbs  to  keep  the  solution  at  a fixed 
temperature.  Thermometers  are  hung  from  the 
cover  to  register  the  temperature  of  the  solution 
at  the  bottoms  of  the  tanks;  while  a four-prong 
glass  tube  is  connected  by  rubber  tubing  with  stop- 
cocks which  are  attached  to  the  three  tanks.  A 
long  rubber  tube  communicates  with  the  lower 
glass  prong,  which  in  turn  is  attached  to  a three- 
way  valve.  One  prong  of  the  three-way  valve  is 
perpendicular,  having  two  feet  of  rubber  tubing 
for  suction,  conveying  the  outflow  into  a large 
bottle.  The  other  prong,  which  points  parallel  to 
the  patient,  is  provided  with  a tube-turner  joined 
by  means  of  rubber  tubing  to  a straight  glass  tube 
used  to  connect  the  rectal  tube.  There  is  also  an 
observation  point  where  one  may  watch  the  return. 
The  three-way  valve  rests  on  a folding  arm,  fas- 
tened to  a special  operating  table  provided  with  a 
flush  and  a glass  bowl,  with  an  electric  light  to 
facilitate  the  inspection  and  measurement  of  the 
discharge  from  the  bowels. 

After  an  experience  extending  over  more  than 
ten  years  I have  found  to  be  most  satisfactory  the 
alternate  use  of  solutions  made  up  by  the  follow- 
ing formulas : 


108 


COLONIC  THERAPY 


First  Day: 

Solution  in  three-gallon  tank: 

Solution  of  chlorinated  soda  (dilute)*;  temperature, 
37°  C. 

Solution  in  small  tank: 

Colloidal  silver,**  . . . 1:8000;  temperature,  50°  C. 
Second  Day: 

Solution  in  three-gallon  tank: 

Solution  of  chlorinated  soda  (dilute).* 

Solution  in  small  tank: 

Two  teaspoonfuls  of  the  following  solution  to  a quart  of 


water;  temperature  50°  C. 

85%  phosphoric  acid 3 drams. 

Hydrochloric  acid  (C.P.) 6 drams. 

Potassium  permanganate 1 dram. 


Distilled  water  enough  to  make  one  gallon. 

Third  Day: 

Solution  in  three-gallon  tank: 

Mix:  Solution  of  chlorinated  soda  (dilute).* 

Sodium  carbonate,  1 dram  to  the  quart. 

Solution  in  small  tank: 

Mix:  Sodium  salicylate  % ounce. 

Sodium  phosphate  4 ounces. 

Temperature  50°  C. 

* Chlorinated  soda  is  a solution  of  chlorid  of  lime  (1  gm.)  and 
carbonate  of  soda  (2  gm.)  in  water.  As  Javelle  water,  it  was  first 
in  use  as  a clothes  bleach,  but  in  the  40  years  since  its  introduction 
it  has  also  been  known  as  Labarraque’s  disinfecting  solution,  chlora- 
zene,  Dakin’s  solution,  and  zonite.  There  is  some  slight  variation  in 
these  different  solutions.  The  solution  was  used  30  years  ago  in 
St.  Luke’s  Hospital,  New  York,  for  cure  of  varicose  ulcers.  Dr. 
Frank  Markoe  used  it  in  Bellevue  Hospital,  New  York,  28  years  ago 
as  a hand  solution  and  to  scrub  the  skin  before  operating.  I have 
used  it  in  my  work  for  the  last  15  years  for  scrubbing  operating 
tables,  and  as  a hand  solution  and  general  deodorizer.  The  solutions 
listed  in  this  work  are  based  on  the  use  of  zonite  (1:100  in  water),  a 
stabilized  solution  of  chlorinated  soda  not  in  U.  S.  P.  strength.  In 
other  forms  the  solution  has  a tendency  to  deteriorate  rapidly. 

**  I have  been  employing  the  “collene”  brand  of  colloidal  silver. 


TECHNIC  OF  COLONIC  IRRIGATION  109 

When  using  turpentine,  kerosene,  or  any  oily 
substance,  mix  with  an  ounce  of  ichthyol  to  eight 
ounces  of  water,  which  will  form  an  emulsion.  By 
uncoupling  the  rectal  tube — the  tube  remaining  in 
the  bowel — this  solution  can  be  applied  with  a 
large,  hard-rubber  syringe  through  the  rectal  tube. 
Solution  of  emetin,  three  grains  to  a quart,  should 
be  used  on  alternate  days  with  quinin,  gr.  100  to 
the  quart,  when  it  is  desired  to  destroy  parasites, 
including  ameba. 

The  solution  in  the  large  tank  serves  three  pur- 
poses: First,  as  an  antiseptic  to  wash  the  intestine; 
second,  to  clean  the  intestine  of  feces  and  gas ; and 
third,  to  place  and  advance  the  tube.  Therefore, 
its  normal  temperature  should  be  such  as  to  pre- 
vent unnecessary  peristalsis.  When  the  tube  is 
placed,  the  high-temperature  solution  in  the  small 
tank  is  applied,  if  indications  warrant  a high- 
temperature  solution.  If  in  doubt,  a normal  tem- 
perature should  be  used,  depending  upon  the  ex- 
isting conditions. 

These  solutions  may  be  modified  and  changed  as 
the  conditions  warrant.  Where  bleeding  is  pres- 
ent, the  solution  of  colloidal  silver  in  the  small  tank 
is  used  in  the  proportions  of  1 : 4000.  This  solution 
is  very  effective  in  stopping  hemorrhages  and  may 
be  used  daily.  Bleeding  from  the  colon  is  most 
commonly  the  result  of  ulcerations,  but  these 
ulcerations  when  properly  treated  will  readily  sub- 


110 


COLONIC  THERAPY 


side.  When  the  hemorrhage  is  from  the  pelvic 
colon,  it  is  more  apt  to  be  bright  red;  farther  up 
the  intestine  it  is  generally  found  in  dark,  almost 
black  clots,  but  not  necessarily  so,  since  it  depends 
upon  the  action  of  the  chemicals  and  the  placement 
of  the  tube,  whether  or  not  it  comes  in  direct  con- 
tact with  the  point  of  hemorrhage.  When  mixed 
with  feces,  the  blood  is  dark  brown,  and  its  amount 
can  be  approximately  estimated  by  the  depth  of 
the  positive  color  reaction  of  the  benzidin  test. 
But  in  applying  these  tests,  one  must  be  mindful 
of  the  amount  of  meat  in  the  patient’s  diet.  The 
digestive  juices  must  always  be  taken  into  con- 
sideration, as  I have  seen  cases,  where  the  patient 
was  on  a red  meat  diet,  in  which  no  positive  blood 
reaction  was  found.  On  the  other  hand,  I have 
removed  quantities  of  solution  colored  red  by  the 
blood  from  a duodenal  ulcer.  I have  also  removed 
feces  from  the  cecum  which  were  bright  yellow  and 
showed  marked  blood  reaction,  likewise  due  to  the 
bleeding  from  a duodenal  ulcer. 

The  rectum,  sigmoid  and  cecum  are  the  most 
common  points  of  hemorrhage,  but  we  can  find  it 
in  many  locations  in  the  colon,  depending  upon  the 
anatomical  defects  which  follow  ptosis.  The 
cecum  is  more  often  distended  than  any  other  part 
of  the  colon,  angulation  of  the  flexures  being  fre- 
quently the  cause.  When  this  distention  exists,  we 
may  expect  to  find  ulcerations  in  many  forms,  and 


TECHNIC  OF  COLONIC  IRRIGATION  111 

such  phenomena  as  sharp  pains  in  the  vicinity  of 
the  hepatic  flexure  extending  to  the  back  on  the 
right  side,  falsely  suggesting  gall-bladder  dis- 
turbance, or  pains  and  symptoms  identical  with 
those  of  an  inflamed  appendix.  Though  this  con- 
dition can  be  easily  detected,  caution  must  be  used 
in  unloading  a distended  cecum,  as  perforation 
due  to  ulceration  has  occurred  and  has  at  times 
even  caused  death. 

The  solution  in  the  large  tank  should  contain 
solution  of  chlorinated  soda  (dilute),  at  37°  C., 
and  in  the  small  tank  six  to  eight  ounces  of  sodium 
phosphate  and  an  ounce  of  sodium  salicylate  to  a 
quart  of  solution  at  50°  C.,  the  patient  being  kept 
on  the  left  side.  When  irrigating,  never  allow 
more  than  a few  ounces  of  solution  to  remain  in  the 
intestine  at  a time.  The  object  is  to  open  the 
flexures;  and  the  feces  and  gases  may  be  removed 
from  the  rectum  and  sigmoid,  the  splenic  flexure 
opened  up,  and  the  transverse  colon  cleansed  by 
siphoning.  I have  often  given  relief  in  this  way, 
and  have  removed  quantities  of  feces  from  the 
transverse  colon,  relieving  the  cecum,  after  reach- 
ing the  splenic  flexure. 

When  the  transverse  colon  is  sufficiently  empty, 
fill  it  with  the  solution  from  the  small  tank,  remove 
the  tube,  and  raise  the  patient  to  a sitting  position 
with  instruction  to  relax  the  muscles  but  not  to 
force  a bowel  movement.  A quantity  of  fluid  will 


112 


COLONIC  THERAPY 


remain  in  the  colon,  and  the  following  day  great 
quantities  of  feces  can  be  removed,  as  it  generally 
requires  from  eight  to  twenty-four  hours  for  a 
physiologic  action  to  result  from  sodium  phosphate 
and  sodium  salicylate.  Following  a violent  dis- 
tention of  the  cecum,  some  hemorrhage  is  likely  to 
take  place.  When  this  occurs,  a hot  solution  of 
colloidal  silver  should  be  employed.31 

Absorption  of  solutions  from  the  intestines  is  not 
merely  a simple,  physical  phenomenon  which  can 
be  sufficiently  explained  by  the  process  of  filtration 
or  osmosis;  it  depends  upon  the  vital  activity  of 
the  intestinal  epithelium.  When  the  intestine  is 
unable  to  expel  the  solution  because  of  physical 
defects,  the  solution  may  be  absorbed  rapidly  or, 
again,  it  may  remain  in  the  colon  for  hours.  W7e 
know  that  when  stasis  exists,  absorption  is  less 
rapid,  but  we  also  know  that  more  solution  is  ab- 
sorbed in  the  presence  of  stasis.  When  irrigating, 
it  is  well  to  bear  in  mind  that  intestinal  distention 
increases  absorption,  and  that  in  the  colon  some 
chemicals  are  more  easily  absorbed  than  others. 
A mixture  of  sodium  salicylate  and  sodium  phos- 
phate is  a powerful  stimulant  to  fluid  secretion  by 
the  villi  fistulae  of  the  colon  and  ileum,  a compara- 
tively small  quantity  of  these  chemicals  being 
absorbed  into  the  blood  stream;  but  potassium 
iodid  applied  in  the  colon  is  absorbed  into  the  blood 
stream  within  a few  minutes  after  its  administra- 


Fig.  13. — Operating  table  and  irrigator,  showing  the  three-way  valve. 
When  the  treatment  is  concluded,  the  patient  may  be  raised  into 
the  sitting  position  while  still  upon  the  table. 


' • ■: 


TECHNIC  OF  COLONIC  IRRIGATION  113 

tion,  producing  iodism  of  the  mouth.  Solution  of 
chlorinated  soda  (dilute)  is  practically  a local  anti- 
septic on  the  intestinal  wall,  as  is  also  colloidal 
silver  solution.  Quinin  administered  in  the  colon 
in  100  grain  doses  can  rarely  be  detected  by  the 
patient. 

It  is  only  when  atony  is  present  that  the  colon 
becomes  ptosed,  this  ptosis  being  due  to  the  relaxa- 
tion of  the  muscles.  In  many  cases  of  marked 
redundancy  of  the  left  colon  I have  found  the 
cecum  distended  with  residue  very  low  in  the  right 
iliac  fossa.  The  redundancy  of  the  sigmoid  is  due 
to  the  continuous  pulling  of  the  physically  de- 
teriorated muscles  in  an  effort  to  raise  the  impacted 
cecum.  As  these  patients  suffer  from  gas  disten- 
tion, regurgitation,  vomiting  and  other  distressing 
symptoms,  relief  can  be  given  by  passing  the  tube 
into  the  cecum.  Very  little  tone  is  found  in  a colon 
thus  afflicted,  and  the  tube  is  more  readily  passed, 
due  to  the  fact  that  the  weakened  waves  and  con- 
traction of  the  intestine  and  transient  sphincters 
of  the  colon  are  very  easy  to  overcome  with  water- 
pressure,  and  when  a portion  of  the  gut  is  dilated 
it  is  very  slow  to  contract.  Caution  must  be  used 
in  this  condition,  however,  since,  if  one  is  not  care- 
ful, a great  deal  of  solution  is  apt  to  be  forced  into 
the  cecal  region  and  cause  distention  at  the  wrong 
time.  Where  this  condition  exists,  we  find  that  a 
high-temperature  solution  of  50°  C.  applied  in  the 


114 


COLONIC  THERAPY 


cecum  or  ascending  colon  will  stimulate  constrict- 
ing colon  waves,  which  cause  the  patient  to  expel 
huge  masses  of  feces,  otherwise  irremovable.  To 
produce  peristalsis  sufficient  to  empty  the  cecum, 
this  solution  must  be  applied  in  the  cecal  region. 

In  beginning  an  irrigation,  place  the  patient  on 
the  left  side  provided  the  colon  is  not  transposed. 
Wash  off  the  rectum  with  a solution  of  carbonate 
of  soda  and  chlorid  of  lime;  then  clamp  the  end 
of  the  rectal  tube,  sterilized  and  full  of  solution, 
with  a sponge  forceps;  and  lubricate  the  rectum 
with  sterile  white  vaseline  or,  if  it  is  spastic  or  if 
hemorrhoids  are  present,  with  adrenalin  ointment. 
In  any  condition  of  the  rectum  insert  the  tube  very 
slowly.  Remove  the  sponge  forceps  and  allow 
three  or  four  ounces  of  solution  to  flow  into  the 
rectum.  Reverse  the  three-way  valve  allowing  the 
gas  and  solution  to  escape.  Repeat,  using  the 
same  amount  of  solution,  or  increasing  it  if  neces- 
sary. Irrigate  the  rectum  until  the  returned  solu- 
tion becomes  practically  clear.  With  the  water 
flowing,  advance  the  tube  a short  distance  into  the 
intestine;  then  reverse  the  valve  and  allow  the 
solution  to  escape.  Repeat  this  maneuver  until 
the  solution  comes  away  practically  clear.  In  this 
way  progress  can  be  made  into  the  pelvic  colon. 

Distending  the  colon  and  forcing  the  folds  of 
the  intestine  forward  while  the  water  is  flowing 
is  but  one  method  of  advancing.  Sometimes  the 


TECHNIC  OF  COLONIC  IRRIGATION  115 

condition  of  the  intestine  is  not  amenable  to  this 
technic.  It  may  be  necessary  to  distend  the  intes- 
tine, after  which  the  reverse  valve  is  thrown  open 
allowing  the  water  to  escape,  and  passing  the  tube 
at  the  same  time.  In  this  way  the  intestinal  wave 
will  be  encountered  and  the  gut  will  slip  over  the 
tube  as  it  meets  the  wave  or  contraction.  In  like 
manner,  where  a great  quantity  of  feces  and  gas 
lies  beyond  the  colon  sphincter,  when  the  tube  has 
been  advanced  and  has  come  in  contact  with  the 
contracted  portion  of  the  intestine,  it  will  be  pos- 
sible to  distend  the  intestine,  and  then  draw  back 
the  tube  with  the  valve  opened.  By  this  method  a 
transient  sphincter  of  the  colon  may  be  induced 
to  relax,  and  a wave  will  follow  the  tube  which  will 
allow  the  gas  and  feces  to  escape.  When  this  is 
accomplished,  the  colon  should  be  dilated  and  the 
tube  passed  simultaneously,  before  the  gut  has 
time  to  contract  further. 

The  amount  of  solution  put  into  the  intestine 
should  be  carefully  gauged,  as  often  in  certain  con- 
ditions control  may  be  lost;  for  example,  perhaps 
a turn  cannot  be  made  at  the  splenic  flexure,  and 
the  solution  will  flow  over  into  a large  redundancy 
in  the  transverse  colon,  and  cannot  be  removed, 
and  the  resulting  distention  of  the  redundancy 
may  cause  a contraction  and  force  the  water  still 
further  over  into  the  cecum,  or — if  the  ileocecal 
valve  is  incompetent — even  into  the  ileum.  When 


116 


COLONIC  THERAPY 


confronted  with  this  condition,  the  tube  must  be 
drawn  back  a few  inches  and  the  flexure  dilated. 
It  will  then  be  possible  to  siphon.  If  not,  the  tube 
must  still  be  retracted.  The  patient  being  on  the 
left  side,  gravity  is  in  the  operator’s  favor. 

Again  perhaps  there  may  be  a floating  and 
stretched  transverse  colon,  persistently  ptosed  to 
the  left,  which  is  weighted  with  feces  and  solution ; 
this  is  likely  to  press  against  the  tube  and  cause  it 
to  kink.  If  this  or  similar  conditions  occur,  turn 
the  patient  on  his  back,  carefully  regulating  the 
amount  of  solution  allowed  to  flow  into  the  intes- 
tine. Under  these  conditions,  the  tube  must  be 
passed  with  only  a small  amount  of  solution,  fre- 
quently throwing  open  the  outflow,  until  it  is  pos- 
sible to  siphon  out  the  feces  and  solution  locked 
in  the  intestine.  In  a large  atonic  intestine  dis- 
tended with  feces  and  gas,  the  tube  will  often  hug 
the  upper  surface  of  the  gut  where  only  gas  is 
present.  The  solution  when  flowing  into  the  colon 
will  go  to  the  bottom,  and  when  the  valve  is  re- 
versed it  will  be  found  that  the  tube  is  filled  with 
gas.  The  only  way  to  overcome  this  is  to  remove 
the  tube  slowly,  with  the  valve  open  (which  per- 
mits the  gas  to  rush  out)  ; then  refill  the  tube  with 
solution,  reinsert  it  into  the  rectum;  and  continue 
as  before.  Allow  but  a few  ounces  of  solution  to 
flow;  then  reverse  the  valve.  The  gas  may  have 
followed  the  tube  down  to  the  rectum  and  here 


TECHNIC  OF  COLONIC  IRRIGATION  117 

it  can  be  removed.  When  the  sigmoid  is  reached, 
change  the  position  of  the  patient,  as  by  so  doing 
any  remaining  gas  will  be  more  apt  to  be  removed. 
A gas  pocket  in  the  intestine  is  generally  coinci- 
dent with  the  presence  of  feces,  and  is  very  difficult 
to  remove. 

It  may  sometimes  be  necessary  to  withdraw  the 
tube  wholly  under  these  conditions.  If  so,  distend 
the  colon  with  hot  solution,  remove  the  tube,  and 
allow  the  patient  to  expel.  After  this  has  been 
accomplished,  the  irrigation  may  be  continued. 

There  have  been  so  many  inquiries  as  to  the 
danger  of  passing  cecum  tubes  in  the  colon,  that 
I will  avail  myself  of  this  opportunity  to  say  that 
120,000  treatments  have  been  given  in  my  clinic 
without  the  slightest  injury  or  mishap,  other  than 
occasionally  a slight  local  pain  due  to  spasms  or 
the  opening  of  an  angle,  and  this  was  felt  only 
during  the  operation. 


CHAPTER  VII 


SPECIAL  APPLICATIONS  OF  COLONIC  IREIGATION 

Colonic  atony — Treatment  of  fecal  impaction  following 
milk  diet — Causal  organism  in  arthritis — Method  of  irrigating 
a spastic  colon— Bacterial  colonization — Irrigating  in  the 
presence  of  putrefactive  foci — Stimulating  effect  of  irrigation 
— Fecal  impaction  simulating  malignancy — Irrigation  when 
malignancy  is  suspected — Dilatation  of  colonic  angulations 
and  flexures — Preparation  for  x-ray  observation. 


CHAPTER  VII 


SPECIAL  APPLICATIONS  OF  COLONIC  IRRIGATION 

Colonic  atony — Treatment  of  fecal  impaction  following 
milk  diet — Causal  organism  in  arthritis — Method  of  irrigating 
a spastic  colon — Bacterial  colonization — ‘Irrigating  in  the 
presence  of  putrefactive  foci — Stimulating  effect  of  irrigation 
— Fecal  impaction  simulating  malignancy — Irrigation  when 
malignancy  is  suspected — Dilatation  of  colonic  angulations 
and  flexures — Preparation  for  x-ray  observation. 

In  many  atonic  conditions  of  the  colon  a tube 
can  be  readily  passed  into  the  cecum.  An  illus- 
trative case  is  that  of  a boy  fourteen  years  of  age, 
who  was  confined  to  bed  with  a distended  abdomen 
(the  intestinal  waves  being  apparently  dormant), 
arthritis  of  eight  weeks’  standing,  swelling  of  the 
joints,  and  a daily  temperature  range  of  from 
101°  to  102.5°  F.  The  patient,  who  had  been 
taken  off  a milk  diet  two  weeks  previously  and 
put  on  a soft  diet,  was  greatly  reduced  in  weight. 
Though  it  was  difficult  to  outline  the  colon  so  as  to 
locate  any  fecal  mass,  dulness  over  the  right  iliac 
fossa  was  very  marked.  The  simple  passing  of  a 
tube  containing  a solution  of  chlorinated  soda 

(dilute)  at  37°  C.  through  the  colon  caused  the 

121 


122 


COLONIC  THERAPY 


expulsion  of  great  quantities  of  gas  with  small 
fragments  of  feces  and  mucus.  From  the  cecum, 
a large  amount  of  variously  colored  feces  was  re- 
moved which  included  small  white  balls  of  milk 
curds.  A quart  of  solution  containing  one  ounce 
of  sodium  salicylate  and  six  ounces  of  sodium  phos- 
phate at  a temperature  of  51°  C.  was  applied  in 
the  cecum.  As  soon  as  the  patient  was  placed  on 
a commode  the  colon  immediately  contracted  and 
expelled  a large  amount  of  dark-brown,  offensive 
residue,  including  six  hard  white  chunks  as  large 
as  golf  balls,  composed  of  putrefying  milk  curds, 
which  had  accumulated  and  lain  in  the  cecum  for 
at  least  two  weeks.  These  feces  upon  examination 
showed  a marked  streptococcus  infection.  Follow- 
ing the  treatment  the  abdomen  relaxed,  so  that  it 
was  easy  to  locate  the  organs,  the  dulness  over  the 
cecum  disappeared,  and  the  temperature  dropped 
to  normal  that  evening.  After  five  similar  treat- 
ments the  joints  were  approaching  their  normal 
condition  and  there  was  no  further  rise  of  tempera- 
ture. After  treatment  for  two  weeks  with  solu- 
tions of  colloidal  silver  alternating  with  acid  solu- 
tions made  up  according  to  the  formula  previously 
given,  with  the  addition  of  a nightly  compound 
carthartic  pill  containing  one-half  grain  of  calo- 
mel, the  following  mixture  was  administered  at 
night : 

One  and  a half  ounces  of  castor  oil;  ten  minims 


APPLICATIONS  OF  COLONIC  IRRIGATION  123 

of  tincture  of  iodin;  and  three  grains  of  menthol. 
This  was  followed  by  eight  ounces  of  citrate  of 
magnesia  in  the  morning.  A daily  implantation  of 
Bacillus  acidophilus  and  Bacillus  bulgancus  cul- 
ture was  made  until  eight  plants  had  been  given. 
A solution  of  sodium  phosphate  and  sodium 
salicylate  was  given  every  fourth  day  as  a cecum 
douche  following  an  irrigation  of  sterile  water. 
Implantations  of  culture  were  given  three  times 
a week  for  six  weeks.  Bacillus  acidophilus  milk 
was  administered  orally;  at  the  end  of  this  period, 
the  patient’s  condition  was  normal. 

The  mechanism  of  the  therapy  in  this  particular 
case  is  easily  understood,  as  the  focus  of  infection 
was  found  in  the  cecum  where  curative  measures 
could  be  applied  without  difficulty.  The  medica- 
ments used  were  stimulants  to  the  endocrine  sys- 
tem and  producers  of  metabolic  drainage  rather 
than  direct  systemic  specifics.  The  conditions  ex- 
isting here  were  due  to  a streptococcus  infection, 
though  arthritis  is  not  always  produced  by  the 
streptococcus  as  several  other  putrefactive  micro- 
organisms, including  staphylococcus,  may  be  the 
primary  cause  of  arthritis.  The  tube  could  be 
readily  passed,  as  there  was  very  little  ptosis  of 
the  colon  and  the  flexures  were  not  angulated.  If 
the  same  condition  had  existed  in  the  cecum  to- 
gether with  malformation  and  loops  and  angula- 
tion at  the  flexure  and  perhaps  a spastic  condition, 


124 


COLONIC  THERAPY 


the  results  would  not  have  been  obtained  so 
rapidly.  As  it  is,  it  very  frequently  happens  in 
irrigating  that  spasms  of  the  pelvic  colon  make  it 
painful  to  pass  a tube  beyond  this  spasm.  Under 
such  circumstances,  it  is  advisable  to  use  adrenalin 
ointment  as  a lubricant  on  the  tube ; and  to  employ 
a very  weak  solution  of  chlorinated  soda  (zonite, 
1:500)  with  a solution  of  colloidal  silver  at  35°  C., 
applied  in  the  spastic  sigmoid.  A small  rectal  tube, 
known  as  a “tracer,”  is  the  best  instrument  for 
this  purpose.  The  tube  can  be  passed  during  the 
period  of  relaxation  between  spasms.  During  the 
spasm  the  outflow  must  be  left  open,  and  when 
relaxation  takes  place  the  water  is  thrown  on,  but 
no  attempt  made  to  pass  the  tube.  If  the  spasm  re- 
occurs, the  outflow  is  again  thrown  open,  careful 
observation  being  made  as  to  whether  the  tube  is 
free.  When  it  is  free,  the  solution  may  be  turned 
on  and  the  tube  passed  with  as  great  speed  as  the 
feeling  of  clearance  ahead  allows.  If  the  tube 
goes  through  the  sigmoid,  no  further  advance 
should  be  made,  but  the  small  tank  with  the  solu- 
tion of  colloidal  silver  turned  on  and  if  possible, 
the  contents  of  the  tank  emptied  in  the  colon.  The 
object  of  this  is  to  dilate  the  constricted  area  with 
hot  solution  which,  when  expelled,  will  automati- 
cally apply  itself  to  the  distended  wall  of  the  in- 
testine. In  treating  a spastic  colon,  the  use  of 
any  irritating  catharsis  as  an  auxiliary  should  be 


Fig.  14.-  Roentgenoscopic  view  of  colon,  following  examination  and 
initial  treatment.  The  figure  shows  the  faint  outline  of  a large 
fecal  impaction  in  the  cecum,  which  is  resting  against  the  redundant 
sigmoid.  In  the  middle  third  of  the  transverse  colon  a faint 
shadow  is  visible.  As  the  colon  displays  no  sacculi,  it  is  evident 
that  the  impaction  of  feces  prevented  the  complete  filling  by  the 
barium  meal. 


<s 


APPLICATIONS  OF  COLONIC  IRRIGATION  125 

avoided,  though  a mild  bland  laxative  may  be 
safely  given.  The  patient  should  be  irrigated  in 
the  afternoon. 

In  a few  days  the  spastic  condition  will  usually 
subside,  although  it  sometimes  exists  in  a lesser 
degree  until  after  the  implantation  with  Bacillus 
acidophilus  and  Bacillus  bulgaricus  culture,  when 
it  always  disappears.  Very  often  there  will  be  a 
spastic  anus,  which  is  almost  always  produced  by 
inflammation  or  an  ulcer  within  the  rectum.  This 
is,  however,  very  easily  eradicated,  usually  after 
only  a few  treatments.  The  necessity  for  daily 
irrigations  will  be  apparent  when  we  consider  that 
we  are  aiming  to  reach  the  cecum,  the  portion  of 
the  alimentary  canal  which  is  the  point  most  favor- 
able for  bacterial  growth.  Under  normal  condi- 
tions the  bacteria  spread  downward  through  the 
colon,  and  when  putrefactive  microorganisms  gain 
the  ascendancy  their  presence  involves  the  nerve 
centers  and  lowers  muscular  tone,  producing  stasis 
and  retardation  of  the  fecal  current,  even  inducing 
incompetency  of  the  ileocecal  valve.  Bacterial 
colonization  may  spread  upward  into  the  ileum  as 
well  as  downward  in  the  colon.  No  matter  what 
obstacle  lies  in  the  way,  before  substantial  results 
can  be  obtained  this  portion  of  the  alimentary 
canal  must  be  entered  and  when  this  point  is 
reached  not  alone  has  the  entire  colon  been  cleaned 
but  access  has  been  gained  to  the  terminal  ileum. 


126 


COLONIC  THERAPY 


If  there  is  an  ileocecal  valve  incompetency,  dilating 
the  cecum  with  a hot  medicated  solution  auto- 
matically allows  the  application  of  solution  in  the 
ileum  and  the  drainage  of  whatever  putrefactive 
organisms  exist  there.  There  is  no  technic  de- 
manding more  practice  and  experience  than  that 
of  acquiring  the  “feel”  that  will  enable  the  oper- 
ator at  the  lower  end  of  a 51 -inch  cecum  tube  to 
know  that  the  tip  of  this  tube  is  going  clear,  or 
that  it  is  coming  in  contact  with  a transient  colon 
sphincter,  or  other  obstacles.  Previously  obtained 
experience  will  enable  him  to  judge  whether  be- 
yond this  sphincter  lies  a mass  of  feces  and  gas, 
whether  there  is  a constriction  produced  by  a focus 
of  a putrefactive  microorganism  forming  an  exu- 
date upon  the  intestinal  wall,  and  producing,  by 
inflammation,  a more  sensitive  area  in  the  gut,  or 
whether  both  the  focus  of  infection  and  an  impac- 
tion of  feces  and  gas  will  be  encountered. 

If  there  is  a transient  sphincter  of  the  colon,  the 
flow  of  water  in  the  gut  will  be  checked,  whereupon 
the  tube  must  be  pulled  back  a few  inches,  the  valve 
thrown  open,  and  if  the  sphincter  relaxes  there 
will  be  a return  flow  of  feces.  If  not,  dilate  the 
intestine,  and  pass  the  tube  forward,  as  the  conical- 
pointed  tube  will  aid  in  opening  the  sphincter. 
The  valve  should  then  be  opened  to  see  if  the  tip 
• has  passed  beyond  the  transient  sphincter.  If  so, 
the  mass  of  feces  and  gas  can  be  easily  removed. 


APPLICATIONS  OF  COLONIC  IRRIGATION  127 

If,  on  the  other  hand,  the  constriction  is  produced 
by  a focus  of  infection,  the  tip  may  not  be  able 
to  pass  this  point.  The  medicated  contents  of  the 
small  tank  should  then  be  applied.  After  distend- 
ing the  gut  to  a point  where  the  solution  begins  to 
flow  slowly,  remove  the  tube  with  the  solution  still 
flowing,  and  allow  the  patient  to  expel. 

The  passing  of  the  rectal  tube  within  the  colon 
stimulates  the  intestinal  villi  fistulae  to  excretion. 
The  presence  of  the  tube  and  the  flow  of  water 
upward  raise  the  lumen  and  temporarily  relieve 
the  ptosis  of  the  part,  straightening  out  large  and 
small  invaginated  areas,  releasing  retained  mucus, 
intestinal  interlining  adhesions,  and  small  impac- 
tions of  embedded  feces.  The  action  of  the  anti- 
septic solution  destroys  the  colonies  of  organisms 
which  are  causing  the  constriction,  thus  removing 
the  exudate  and  releasing  the  impacted  content. 
The  daily  passage  of  the  tube  to  the  cecum  con- 
tinually lifts  the  intestine  into  its  normal  position 
and  the  transverse  colon  is  elevated  into  a superior 
arc. 

The  result  of  returning  the  intestinal  organs  to 
their  proper  relations  and  improving  their  mus- 
cular tone  is  clearly  demonstrated  in  the  roent- 
genoscopic  view  (Fig.  14  and  15).  The  patient 
was  a woman  sixty-five  years  of  age  who  had  taken 
a laxative  every  night  for  thirty  years.  She  com- 
plained that  for  the  preceding  five  weeks  she  had 


128 


COLONIC  THEEAPY 


suffered  from  loss  of  appetite,  almost  continual 
nausea,  gas  pressure  and  discomfort  after  eating, 
vomiting,  dull  pain  in  the  cecal  region,  and  a 
sensation  of  “goneness”  and  extreme  exhaustion. 
Several  doses  of  castor  oil  and  calomel  had  failed 
to  give  any  relief.  Her  appearance  was  suggestive 
of  malignant  disease  and  the  abdomen  was  dis- 
tended. Palpation  showed  a slight  tenderness  in 
the  cecal  region,  and  in  the  right  iliac  fossa  was  a 
rounded  indurated  mass  the  size  of  an  orange, 
moderately  tender  to  palpation,  and  fixed,  so  that 
it  gave  the  impression  either  of  a tumor  of  the  pos- 
terior abdominal  wall,  or  a sarcoma  of  the  ileum. 
Roentgenoscopy  showed  a fair  filling  of  all  parts 
of  the  large  intestine  except  the  cecum,  which  cast 
a very  pale  shadow,  indicating  that  the  barium 
meal  was  not  passing  through  the  cecum  in  a nor- 
mal manner,  either  on  account  of  pressure  from 
without,  or  because  of  occlusion  of  the  lumen  by 
the  presence  of  a foreign  body. 

Three  physicians  of  recognized  authority,  all  of 
whom  had  made  a diagnosis  of  possible  malig- 
nancy, agreed  that  the  colon  should  be  thoroughly 
cleaned  out.  At  the  second  treatment  I was  able 
to  reach  the  cecum,  and  by  making  use  of  a solu- 
tion of  peroxid  of  hydrogen,  with  considerable 
manipulation  was  able  to  break  up  the  mass,  which 
proved  to  be  an  impaction  of  feces.  The  cecum 
was  then  irrigated  with  three  gallons  of  chlorinated 


Fig.  15. — Same  case  as  Fig.  14,  showing  normal  tone  and  position  of 
colon  after  six  weeks’  treatment,  using  antiseptic  solutions  and 
implantations  of  Bacillus  acidophilus  and  Bacillus  bulgaricus. 
Sigmoid  redundancy  entirely  reduced;  well  formed  colon  sacculi 
indicate  restoration  of  a normal  tonus.  A transient  sphincter  is 
distinctly  outlined,  and  the  traction  of  the  vermiform  muscles, 
forcing  the  splenic  flexure  into  a moving  loop,  is  clearly  evident. 


APPLICATIONS  OF  COLONIC  IRRIGATION  129 

soda  solution,  followed  by  two  quarts  of  colloidal 
silver  solution — 1:8000 — at  a temperature  of  50° 
C.,  which  was  allowed  to  remain  in  the  cecum.  As 
soon  as  the  impacted  fecal  mass  was  removed,  the 
patient  for  the  first  time  in  five  weeks  experienced 
relief  from  her  most  distressing  symptoms.  After 
thorough  irrigation  and  disinfection  of  the  colon 
and  the  implantation  of  Bacillus  acidophilus , her 
whole  appearance  was  greatly  improved,  and  her 
general  health  is  now  excellent.  The  mass  in  the 
right  iliac  fossa  has  entirely  disappeared  and  a 
second  x-ray  shows  the  barium  meal  normally  fill- 
ing the  entire  length  of  the  colon,  including  the 
cecum. 

Figure  14  shows  the  distinct  outline  of  a cecal 
impaction  resting  against  the  large-sized  floating 
sigmoid.  This  redundancy  is  doubtless  due  to  the 
traction  exerted  by  the  vermiform  muscles  which 
have  lost  their  tone  and  become  stretched  to  such 
an  extent  that  they  are  unable  to  raise  the  impac- 
tion. In  Figure  15,  the  colon  will  be  seen  in  a 
normal  position,  following  six  weeks’  treatment 
with  no  other  aid  than  the  use  of  antiseptic  solu- 
tions and  the  implantation  of  B acdlus  acidophilus 
culture.  The  large  redundancy  has  entirely  dis- 
appeared. The  well  formed  colon  sacculi  show 
that  the  tonus  is  normal  in  eveiy  respect;  and  a 
transient  sphincter  is  clearly  outlined,  the  taenia 
coli  drawing  the  colon  below  the  splenic  flexure 


130 


COLONIC  THERAPY 


into  a moving  loop.  The  pictures  clearly  demon- 
strate the  fallacy  of  those  who — because  of  lack 
of  experience — claim  that  irrigations  may  dilate 
the  colon.  On  the  contrary,  irrigations  when 
properly  administered  actually  offer  the  additional 
advantage  of  contracting  the  colon.  Excessive 
residue — including  bacteria — is  removed  and  the 
passage  of  the  colon  tube  stimulates  the  organ. 
The  high-temperature  solution  increases  the  cir- 
culation, for,  as  the  angles  and  kinks  are  removed, 
blood  stasis  is  abolished  in  the  veins  running  par- 
allel with  the  intestine;  a condition  of  angulation 
always  tending  to  produce  varicose  veins  and  blood 
stasis.  From  impeded  circulation  will  result  mal- 
nutrition of  the  organ,  which  in  turn  causes  a gen- 
eral atony,  and  this,  it  is  needless  to  say,  will  be 
accompanied  by  fecal  immobility. 

Figure  16  illustrates  the  appearance  of  forty-six 
inches  of  rectal  tube  in  the  colon.  I will  describe 
the  technic  used  in  passing  the  tube  as  it  is  shown 
in  this  particular  case,  and  how  the  peristaltic 
waves  of  the  colon  may  not  only  be  overcome  but 
made  available  to  assist  in  passing  the  tube. 

Figure  17  shows  the  passage  of  a three-pint 
barium  meal,  outlining  the  colon’s  position,  dem- 
onstrating that  the  cecum  and  ascending  colon 
have  risen  in  an  attempt  to  expel  the  tube.  From 
a faint  outline  of  a shadow  it  can  be  seen  that  the 
vermiform  muscle  was  contracting,  thus  raising  the 


Fig.  16. — Roentgenoscopic  view  of  forty-six  inches  of  rectal  tube  in 
the  colon.  The  position  of  the  colon  here  shown  is  only  one  of  a 
great  number  which  may  be  encountered  in  the  course  of  high 
colonic  irrigation. 


APPLICATIONS  OF  COLONIC  IRRIGATION  131 

cecum,  while  the  photograph  was  being  taken. 
This  emphasizes  the  logic  of  my  contention  that 
the  proper  treatment  is  to  apply  hot  solution  in 
the  cecum,  and  also  provides  a picture  of  what 
many  a physician  has  ordered  but  never  succeeded 
in  obtaining,  namely,  “a  high,  hot  colon  irriga- 
tion.” It  likewise  explains  the  feeling  of  relief 
spoken  of  by  so  many  patients  following  the  ad- 
ministration of  a quart  or  more  of  50°  C.  solution 
applied  in  the  cecum,  to  be  later  expelled  by  the 
colon.  The  same  idea  was  in  the  mind  of  Dr. 
Charles  F.  Stokes  while  discussing  a paper  read 
at  the  Yonkers  Academy  of  Medicine,  when  he 
took  exception  to  the  figure  used  by  one  of  the 
speakers  who  had  likened  the  colon  to  an  abscess. 
How,  he  asked,  could  this  tubular  organ  be  com- 
pared to  an  abscess  ? In  his  opinion,  it  more  closely 
resembled  a fistula,  as  in  treating  a fistula  it  would 
be  necessary  to  treat  its  entire  length.  Just  so, 
we  must  give  attention  to  the  entire  length  of  the 
colon. 

In  the  roentgenographic  view,  the  tube  is  passed 
through  a loop  in  the  sigmoid.  Such  a loop  can 
be  widely  dilated  without  causing  much  discom- 
fort to  the  patient,  or  making  it  difficult  to  retain 
the  solution  when  the  fluid  is  thrown  beyond  the 
apex.  The  intestine  is  dilated,  and  the  tube  is 
passed  through  the  splenic  flexure,  but  before  this 
flexure  is  reached  the  loop  in  the  sigmoid  must  he 


132 


COLONIC  THERAPY 


used  as  an  additional  force  to  further  propel  the 
tube.  The  loop  is  first  dilated  by  the  passing  of 
the  tube;  the  water  is  then  turned  on,  and  the 
pressure  caused  by  the  constriction  of  the  loop 
propels  the  point  of  the  tube  still  farther  up  the 
gut.  The  outflow  is  then  released  and  the  tube 
relaxes  in  the  operator’s  hand;  if  the  tube  is  not 
forced  back,  he  will  know  that  it  has  advanced.  In 
this  way  the  splenic  flexure  can  eventually  be 
reached. 

The  patient,  who  has  heretofore  been  lying  on 
his  left  side,  is  now  turned  upon  his  back.  By  this 
change  of  posture  the  splenic  flexure  is  relieved 
of  the  weight  of  gravity,  and  added  power  of  trac- 
tion is  given  to  the  hepatic  flexure,  in  this  way 
aiding  the  tube  to  turn  the  angle,  although  the  loop 
must  still  be  used  as  a driving  force  to  further 
propel  the  tube. 

Figure  17  also  illustrates  the  power  of  the  vermi- 
form muscles  to  contract  the  colon,  as  it  shows 
them  raising  the  cecum  and  ascending  colon  in  an 
attempt  to  expel  the  tube  and  the  barium  meal 
from  within  their  walls.  This  figure  also  demon- 
strates the  expulsive  power  of  the  colon  when  the 
fluid  and  gases  are  allowed  to  escape  following  the 
dilatation  of  a part;  the  colon  in  the  effort  of 
expulsion  will  follow  the  tube  and  even  slip  over 
it.  In  this  way  the  tip  is  advanced  into  the  colon. 

A transient  loop  of  the  colon  may  be  retarded 


Fig.  17. — Colon  filled  with  a barium  meal,  showing  contraction  of  the 
vermiform  muscles  in  the  act  of  raising  the  colon  in  order  to  expel 
its  contents.  A faint  shadow  outlines  the  path  of  the  cecum,  show- 
ing it  in  the  act  of  rising  as  the  picture  was  taken.  In  this  case, 
previous  palpation  clearly  indicated  that  the  cecum  lay  very  low 
in  the  right  iliac  fossa.  The  gas  forced  out  by  the  entrance  of  the 
roentgenographic  meal  can  he  seen  in  the  sigmoid,  holding  back  the 
barium  meal. 


APPLICATIONS  OF  COLONIC  IRRIGATION  133 

by  a large  amount  of  residue;  if  the  intestine  is  in 
a weakened  condition  and  unable  to  expel  it  fur- 
ther, the  mass  becomes  an  immovable  impaction. 
The  life  and  health  of  the  individual  depend  upon 
the  amount  of  residue,  its  quality  and  the  ability 
of  the  intestine  to  remove  the  impaction,  either 
entire  by  a single  convulsive  effort,  or  by  frag- 
ments. If  the  loop  is  not  emptied,  the  wall  of  the 
gut  may  become  infected,  and  adhesions  are  liable 
to  form  which  will  make  the  impaction  more  diffi- 
cult to  remove.  I have  found  that  intestinal  inter- 
lining adhesions  may  be  removed  by  destroying  the 
flora  with  antiseptic  solutions  at  high  temperature, 
the  stimulation  of  the  area  causing  motion  of  the 
part  and  producing  increased  circulation.  Added 
to  this,  by  the  application  of  solution,  we  get  a 
mechanical  action  in  the  distention  and  relaxation 
of  the  gut  with  its  inflow  and  outflow  together 
with  the  passing  of  the  tube.  The  flexibility  of 
the  tube  must  be  left  to  the  operator’s  judgment. 
I find  that  at  first  it  is  better  to  use  a tube  that 
is  sufficiently  flexible  to  go  through  the  loop,  re- 
move the  feces  and  apply  treatment,  later  employ- 
ing a stiff  tube  to  straighten  out  the  loop  by 
mechanical  manipulation.  It  is  of  vital  impor- 
tance to  remove  an  impaction  at  once,  but  more 
time  is  required  to  properly  straighten  out  a loop. 

When  passing  a stiff  and  heavy  tube,  the  oper- 
ator’s movements  must  be  very  deliberate.  A 


134 


COLONIC  THERAPY 


skilled  operator  can  easily  detect  the  gut  swinging 
in  line  to  the  tube,  as  in  many  cases  where  the 
pelvic  colon  is  in  a practically  normal  position  a 
stiff  tube  can  be  passed  to  the  splenic  flexure.  The 
curve  taken  by  the  tube  depends  upon  the  mobility 
of  the  sigmoid.  If  there  is  an  angulation  at  the 
splenic  flexure  which  it  is  desired  to  treat,  but  the 
sigmoid  is  floating  and  the  tube  carries  the  gut 
in  a straight  line  from  the  rectum  to  the  splenic 
flexure,  it  will  be  found  impossible  to  make  a turn 
into  the  transverse  colon,  for  the  tube  will  carry 
the  flexure  with  it  straight  to  the  abdominal  wall. 
This  may  be  avoided  by  using  a flexible  tube  and 
tilting  the  patient  on  the  right  side,  thus  enlisting 
the  aid  of  gravity  in  making  the  turn.  But  on 
the  other  hand,  if  the  sigmoid  is  not  floating  and 
the  tube  bows  to  the  left,  the  point  running  central 
after  passing  the  anterosuperior  spinous  process, 
there  will  be  less  difficulty  in  passing  through 
the  splenic  flexure.  Again,  if  the  transverse  colon 
is  ptosed  in  a V-shape,  a soft  tube  will  have  a ten- 
dency to  point  down  to  the  pubes;  wffiereas,  on 
the  other  hand,  a stiff  tube  slowly  passed  will  be 
likely  to  raise  the  transverse  colon  and  make  it 
possible  to  reach  the  hepatic  flexure.  If  the  oper- 
ator is  not  successful  in  arching  the  stiff  tube  he 
will  not  be  able  to  pass  it  beyond  the  hepatic  flex- 
ure, though  a softer  tube  could  be  passed  through 
the  hepatic  flexure  into  the  cecum.  The  passage  of 


APPLICATIONS  OF  COLONIC  IRRIGATION  135 

a softer  tube  through  an  intestine  is  not,  however, 
as  beneficial  as  that  of  a stiffer  tube.  A stiff  tube 
tends  to  force  the  gut  into  a magnet-shaped  loop, 
while  a softer  tube  is  controlled  by  the  intestine 
and  will  adapt  itself  to  its  loops  and  curves. 

To  relieve  an  angulation  of  a gut  the  point  of 
angulation  must  be  reached  with  the  tube.  The 
solution  is  apt  to  run  ahead  of  the  tube  and  fill 
the  intestine  beyond  the  angle,  so  that  it  has  little 
effect  in  the  way  of  removing  the  constriction. 
But  if  this  does  not  happen,  the  solution  together 
with  the  tube  will  readily  open  any  angle  that  is 
not  due  to  malignancy. 

When  an  angulation  of  the  splenic  and  hepatic 
flexure  is  present,  place  the  patient  on  the  left 
side;  if  a stiff  tube  can  be  passed  to  the  first 
afflicted  point,  the  flexure  should  be  carried  as  far 
as  possible  toward  the  abdominal  wall,  and  then 
dilated.  In  this  way  the  solution  is  very  easily 
siphoned  out.  A high  temperature  solution  can 
be  used  at  this  point  for  irrigating,  and  the  stretch- 
ing of  the  part  will  enable  the  antiseptics  to  be 
more  effectively  applied.  When  this  point  is  suf- 
ficiently dilated  to  enable  a tube  to  be  passed 
through  the  flexure,  if  the  tube  is  running  straight 
across  the  abdomen,  and  the  intestine  sagging 
underneath,  it  will  be  found  that  solution  will  flow 
in,  but  none  will  flow  out.  However,  the  gut  is 
open  so  that  the  patient  can  expel  its  content; 


136 


COLONIC  THERAPY 


apply  the  hot  solution,  remove  the  tube,  and  allow 
the  patient  to  evacuate.  By  thus  applying  the 
treatment,  the  hepatic  angulation  has  also  been 
treated  by  the  solution.  Once  free  access  to  this 
point  is  gained,  substitute  a stiff  tube,  which  will 
now  form  an  arc  so  that  the  point  will  arrive  at 
the  hepatic  flexure  at  an  angle  better  adapted  to 
open  it  up.  The  patient’s  position  when  treating 
an  angulation  of  the  hepatic  flexure  may  be  either 
on  the  left  side,  or  on  the  back,  as  conditions 
indicate. 

In  preparation  for  an  x-ray  of  the  colon,  the 
patient  should  receive  catharsis — castor  oil  fol- 
lowed by  citrate  of  magnesia — and  the  colon 
should  be  treated  by  irrigations  and  cleaned  as 
thoroughly  as  possible,  the  last  irrigation  being 
given  an  hour  before  the  barium  meal  is  ingested. 
It  is  utterly  impossible  to  get  a true  picture  of  the 
colon  when  diverticula  and  pockets  are  filled  with 
feces,  and  portions  of  the  intestine  are  distended 
with  gas,  preventing  filling  with  the  barium.  Often 
a patient  will  be  sent  for  an  x-ray  of  the  colon 
without  any  preparation  whatever,  the  roentgeno- 
graphs later  being  adversely  criticized  for  not  re- 
vealing the  true  condition. 


CHAPTER  VIII 


ANTISEPTICS  AND  BACTEEIAL  IMPLANTATIONS 

Colonic  “clean-up”  and  catharsis — Technic  of  bacterial 
implantation — Relative  merits  of  Bacillus  acidophilus  and 
Bacillus  hulgaricus — Value  of  bacterial  implantations — Neces- 
sity for  thoroughly  cleansing  the  intestinal  canal  previous  to 
implantation — Condition  of  patients  after  bacterial  implanta- 
tion — Bacterial  cultures  — Coincident  administration  of 
catharsis. 


CHAPTER  VIII 


ANTISEPTICS  AND  BACTERIAL  IMPLANTATIONS 

Colonic  “clean-up”  and  catharsis — Technic  of  bacterial 
implantation — Relative  merits  of  Bacillus  acidophilus  and 
Bacillus  bulgaricus — Value  of  bacterial  implantations — Neces- 
sity for  thoroughly  cleansing  the  intestinal  canal  previous  to 
implantation — Condition  of  patients  after  bacterial  implanta- 
tion — Bacterial  cultures  — Coincident  administration  of 
catharsis. 


I find  that  after  the  colon  is  cleansed  and  pre- 
pared with  antiseptic  solution  according  to  the 
method  which  I have  described,  an  implantation  of 
Bacillus  acidophilus  and  Bacillus  bulgaricus  in  the 
colon  and  the  same  cultures  also  administered 
orally  in  the  form  of  milk  are  of  great  therapeutic 
value  in  allaying  inflammation  throughout  the 
whole  extent  of  the  alimentary  canal,  with  the  re- 
sultant increase  of  systemic  drainage.  The  colon 
is  cleansed  with  antiseptic  solutions  for  a period 
of  ten  days  to  two  weeks  and  a compound  cathartic 
pill  containing  a half  grain  of  calomel  is  admin- 
istered nightly. 

The  day  previous  to  planting,  one  and  a half 

ounces  of  castor  oil  containing  ten  minims  of  iodin 

139 


140 


COLONIC  THERAPY 


and  three  grains  of  menthol  are  given,  followed 
by  one  or  more  compound  cathartic  pills  at  bed- 
time and  a bottle  of  citrate  of  magnesia  the  follow- 
ing morning.  That  afternoon  the  patient  receives 
an  irrigation  of  sterile  water  in  order  that  the 
irrigation  tube  may  be  placed  in  the  cecum,  or  as 
high  in  the  colon  as  is  possible.  Then  an  implan- 
tation of  Bacillus  acidophilus  and  Bacillus  bul- 
garicus  is  made,  a pint  to  a quart  of  culture  solu- 
tion with  half  a teaspoonful  of  lactose  or  dextrose, 
being  used  at  a temperature  of  50°  C.  Following 
the  implantation,  the  tube  is  drawn  back  to  the  sig- 
moid, and  the  sigmoid  distended  with  sterile 
water.  This  prevents  the  cecum  from  rising  and 
expelling  the  hot  solution.  The  hot  solution  in  the 
cecum  may  cause  a reverse  peristaltic  wave  carry- 
ing the  fluid  into  the  ileum,  if  there  is  incom- 
petency of  the  ileocecal  valve.  When  the  patient 
complains  of  distention  of  the  sigmoid,  the  tube 
should  be  removed,  the  patient  raised  on  the  oper- 
ating table,  and  allowed  to  expel,  sitting  up.  After 
this  has  been  accomplished  he  should  be  placed  on 
the  left  side  and  a four  ounce  rectal  plant  of 
Bacillus  acidophilus  and  Bacillus  bulgaricus  wTith 
half  a teaspoonful  of  dextrose  or  lactose  at  a tem- 
perature of  50°  C.  should  be  made.  This  can  be 
given  with  a percolator  bottle  and  a catheter,  and 
when  the  colon  is  perfectly  clear  of  feces  and  gas, 
the  hot  solution  will  cause  reverse  waves  which 


Fig.  18. — This  roentgenograph  offers  convincing  evidence  of  the  neces- 
sity of  thoroughly  cleaning  out  the  colon  before  presenting  a pa- 
tient for  roentgenographic  examination.  Many  abnormalities  can 
be  made  out,  including  exaggerated  sacculi,  angulations,  an  incom- 
petent ileocecal  valve,  and  a ptosed  sigmoid. 


ANTISEPTICS  AND  BACTERIAL  IMPLANTATIONS  141 

sometimes  carry  the  solution  as  far  as  the  cecum. 
Following  the  implantation  of  the  culture  the  pa- 
tient should  be  turned  on  the  right  side  so  that 
gravity  will  aid  in  carrying  the  solution  as  far  as 
possible.  When  the  patient  has  been  allowed  to 
lie  for  fifteen  minutes  in  this  position  the  treatment 
is  finished. 

This  procedure  should  be  repeated  daily  for 
three  days;  then  every  other  day  for  three  weeks; 
then  twice  a week  for  three  weeks;  thereafter  an 
occasional  treatment  as  indications  warrant.  Dur- 
ing this  period  four  ounces  of  Bacillus  bulgaricus 
or  Bacillws  acidophilus  milk  is  also  taken  by  mouth 
three  times  a day  before  meals.  This  culture-milk 
should  be  prepared  from  skim-milk,  which,  coming 
in  contact  with  the  acid  of  the  stomach,  forms  clots, 
and  serves  as  a carrier  to  convey  the  bacteria  to 
the  ileum  and  colon. 

After  an  experience  of  many  years  in  treating 
the  colon  with  varying  methods  ranging  from  the 
giving  of  an  enema  consisting  of  different  sub- 
stances, up  to  the  development  of  the  technic  which 
I now  employ,  I find  the  use  of  antiseptics  the 
most  valuable  form  of  treatment.  But  it  has  been 
my  experience  that  no  matter  how  thoroughly  a 
colon  may  have  been  cleansed  the  organ  does  not 
remain  clear  for  any  length  of  time.  Varying 
wild  growths  of  bacteria  soon  make  it  their  habitat 
although  in  some  cases  where  drainage  was  excep- 


142 


COLONIC  THERAPY 


tionally  improved,  the  patient’s  health  has  re- 
mained good.  As  a rule,  however,  the  patient’s 
condition  would  be  satisfactory  only  as  long  as 
the  irrigations  were  continued. 

From  the  treatment  of  more  than  one  thousand 
patients  a year  for  the  past  four  years,  making 
constant  bacterial  examination  of  the  fecal  flora, 
and  clinical  observations  in  collaboration  with 
physicians  of  highest  rank  in  their  profession,  I 
have  adopted  the  following  practice  of  bacterial 
implantation,  modified  according  to  the  results  of 
continuous  “checking  up”  on  the  fecal  flora,  and 
minute  observation  of  the  general  systemic  condi- 
tion of  the  patient:  An  implantation  of  Bacillus 
acidophilus  and  Bacillus  bulgaricus  is  made  in  the 
colon — the  treatment  described  in  the  preceding 
chapters  is  in  preparation  for  this  implantation — 
for  the  establishment  of  a nonputref active  organ- 
ism is  of  enormous  value  in  preserving  health. 
The  value  of  the  results  obtained  from  any  treat- 
ment is  greatly  enhanced  when  the  colon  is  ade- 
quately prepared  and  the  bacillus  properly  culti- 
vated and  implanted.  Examination  of  patients 
returning  for  an  occasional  treatment  after  an 
absence  of  one  to  eight  years,  following  a course  of 
treatment  with  antiseptic  solutions  and  subsequent 
implantation  of  Bacillus  acwtopMlus  and  Bacillus 
bulgaricus , lias  shown  that  a large  majority  of  such 
patients  were  in  perfect  health,  maintaining  a good 


Fig.  19. — Mixed  culture  of  Bacillus  acidophilus  and 
Bacillus  bulgaricus. 


ANTISEPTICS  AND  BACTERIAL  IMPLANTATIONS  143 

growth  of  Bacillus  acidophilus.  Some,  however, 
though  their  health  was  greatly  improved,  still 
suffered  from  fecal  stasis,  notwithstanding  the  fact 
that  they  had  a good  growth  of  Bacillus  acido- 
philus. Other  patients  had  a very  small  growth  of 
Bacillus  acidophilus,  yet  their  health  was  excellent, 
with  no  symptoms  of  fecal  stasis.  The  rest  of  these 
old  patients — about  ten  per  cent — had  a small 
growth  of  Bacillus  acidophilus,  and  while  their 
general  condition  was  better  than  at  first,  still  their 
state  of  health  was  far  from  satisfactory. 

The  colons  of  this  last  group  of  patients  had 
varying  growths  of  putrefactive  bacteria;  some 
corresponded  to  those  of  the  original  slide,  while 
others  had  a greater  and  more  virulent  growth. 
These  patients  were  referred  back  to  their  phy- 
sicians who  were  thoroughly  conversant  with  their 
conditions,  and  another  course  of  irrigations  was 
ordered  in  conjunction  with  a changed  diet,  regu- 
lation of  the  mode  of  living,  of  the  amount  of  exer- 
cise and  rest,  and  stimulation  of  both  the  circu- 
latory and  endocrine  systems.  In  these  patients, 
the  physician  recognized  certain  conditions  that  he 
was  able  to  rectify  by  the  administration  of  appro- 
priate remedies,  and  under  this  regimen  improve- 
ment was  rapid  and  permanent  with  relief  of  the 
general  static  condition  of  the  alimentary  canal 
and  with  a good  growth  of  Bacillus  acidophilus 
present  at  the  termination  of  the  treatment.  This 


144 


COLONIC  THERAPY 


seems  to  indicate  in  a general  way  that  had  these 
remedies  been  applied  during  the  patients’  initial 
treatments  it  would  not  have  been  necessary  for 
them  to  return. 

The  Results  Obtained  from  the  Implantation  of 
Bacillus  acidophilus  and  Bacillus  bulgaricus. — 
Making  a comparison  between  these  two  bacilli: 
Under  the  proper  technic,  Bacillus  acidophilus  can 
be  readily  grown  in  the  colon  and  ileum  and  be- 
come permanently  established  there.  The  life  of 
Bacillus  bulgaricus,  on  the  contrary,  is  very  short; 
though,  exceptionally,  as  when  the  patient’s  diet  is 
largely  of  milk,  such  as  buttermilk,  it  may  persist 
for  some  time.  Bacillus  bulgaricus  has,  however, 
a quick  and  active  fermentative  value.  The  lactic 
acid  that  is  abundantly  thrown  off  by  a luxuriant 
growth  of  Bacillus  bulgaricus  has  a sedative  action 
on  the  alimentary  canal,  and  by  producing  this 
condition  nontoxic  absorption  may  be  quickly 
obtained;  whereas,  when  Bacillus  acidophilus  is 
planted  alone,  therapeutic  results  are  not  obtained 
so  rapidly,  as  it  takes  weeks  and  sometimes  months 
to  establish  a good  growth.  F ollowing  the  implan- 
tation of  Bacillus  acidophilus,  however,  the  record 
of  increased  growth  of  this  organism  in  the  intes- 
tines extends  over  a period  sometimes  as  long  as 
eight  years.  At  the  termination  of  this  period 
the  patient  has  a far  better  growth  than  imme- 
diately after  the  two  months’  treatment. 


Fig.  20. — Bacillus  bidgaricus  in  pure  culture. 


ANTISEPTICS  AND  BACTERIAL  IMPLANTATIONS  145 

No  matter  how  large  a colony  of  Bacillus  acido- 
philus is  present  in  the  alimentary  canal,  when 
fecal  stasis  exists,  due  to  a mechanical  defect  of 
the  tube,  it  is  impossible  to  prevent  putrefactive 
organisms  from  colonizing.  To  introduce  Bacillus 
acidophilus  without  a thorough  preparation  of  the 
colon  is  not  logical.  This  is  especially  true  where 
foci  of  infection  are  produced  by  organisms  such 
as  colon  bacillus,  streptococcus,  staphylococcus, 
Bacillus  aerogenes  capsulatus,  or  other  organisms 
that  produce  gases,  for  these  gases  cause  tremen- 
dous distention  which  makes  it  impossible  for  the 
intestine  to  carry  on  its  normal  function,  and  pro- 
duces abnormally  large  intestines  with  marked 
fecal  stasis. 

The  results  of  my  work  have  positively  proved 
that  a lasting  growth  of  Bacillus  acidophilus  can- 
not possibly  be  produced  in  the  colon  by  the  admin- 
istration of  Bacillus  acidophilus  milk  or  other 
preparation  of  Bacillus  acidophilus  given  by 
mouth;  and,  moreover,  that  no  great  mechanical 
value  can  be  derived  from  such  administration. 
Of  the  patients  presenting  themselves  at  my  insti- 
tution for  treatment  after  taking  Bacillus  acido- 
philus milk  for  periods  varying  from  one  month  to 
one  year,  some  had  a fair  growth  of  Bacillus  acido- 
philus, others  had  none  whatever,  and  their  health 
was  not  improved.  Yet  these  patients  gained 
rapidly  under  the  technic  and  implantation  of 


146 


COLONIC  THERAPY 


Bacillus  acidophilus , as  described  here,  with  the 
addition  of  their  physicians’  therapeutic  super- 
vision. Bacillus  acidophilus  given  by  mouth  with 
large  quantities  of  sugar  of  milk  will  produce  a 
very  good  temporary  growth  in  the  ileum,  but  not 
in  the  colon,  especially  where  the  colon  is  diseased. 
Sugar  of  milk  is  absorbed  by  the  ileum  so  that  very 
little,  if  any,  finds  its  way  to  the  colon  unless  it  is 
given  in  abnormal  dosage.  We  must,  likewise, 
consider  the  effect  of  the  sugar  of  milk  on  the  pa- 
tient’s general  health.  As  we  know,  the  cecum 
is  a fertile  portion  of  the  alimentary  canal  for  the 
growth  of  bacteria,  and  when  this  organ  is  cleansed 
of  residue  and  the  membrane  stimulated  and 
treated  antiseptically  for  a certain  period  of  time, 
large  colonies  of  luxuriantly  growing  Bacillus 
acidophilus  and  Bacillus  bulgancus  being  there- 
after planted  in  the  cecum  in  a solution  made  of 
dextrose  or  lactose,  the  results  are  excellent.  The 
advantage  offered  by  the  use  of  dextrose  is  that 
it  produces  less  gas  than  does  lactose,  but  lactose 
makes  a better  medium  for  the  growth  of  Bacillus 
acidophilus.  As  toxemia  is  more  marked  when 
fecal  stasis  exists  in  the  cecum  than  when  the  re- 
tardation is  in  the  sigmoid,  we  get  better  results 
from  a good  growth  of  Bacillus  acidophilus  in  the 
cecum.  But  as  the  cecum  harbors  more  bacteria 
than  any  other  part  of  the  alimentary  canal,  it 


ANTISEPTICS  AND  BACTERIAL  IMPLANTATIONS  147 

follows  that  this  part  must  be  cleansed  before  we 
can  obtain  results. 

Following  a general  clean-up,  as  described  in 
the  foregoing  chapters,  the  implantation  in  the  ali- 
mentary canal  of  organisms  that  produce  lactic 
acid  should  produce  the  following  results : A 

complete  subsidence  of  inflammation  in  the  alimen- 
tary canal,  including  the  colon,  occurring  some- 
times within  a few  hours  after  its  administration; 
and  in  twenty-four  hours,  the  ability  to  pass  a 
rectal  tube  into  a hitherto  inflamed  or  spastic  colon 
without  the  slightest  discomfort  to  the  patient. 
The  amount  of  residue  that  follows  for  days  and 
even  weeks  is  enormous,  indicating  the  institution 
of  a general  systemic  drainage.  The  residue  is 
generally  very  light  in  color,  this  color  not  being 
produced  by  the  organism,  but  resulting  from  the 
good  drainage  of  the  ileum  and  colon,  which  pre- 
vents the  residue  from  being  retained  in  the  colon 
sufficiently  long  for  the  color  to  change.  Follow- 
ing an  implantation,  we  get  mucus  from  the  ileum 
which  is  of  a light  yellow  color,  quite  different  from 
that  of  the  colon  whence  we  remove  large  dark- 
colored  clots,  the  matrix  consisting  of  mucus  and 
membranous  strips. 

The  following  medium,  I find,  produces  a 
rugged  and  luxuriant  growth  of  Bacillus  acido- 
philus for  colon  implantations : 


148 


COLONIC  THERAPY 


Nutrient  agar  (Difco)*  9 grams; 

Nutrient  broth  (Difco)* 26  grams; 

Table  salt 40  grams; 

Glycerin  9 ounces; 

Dextrose  89  grams ; 


7 slices  toast  in  1 qt.  solution; 

Water  to  make  2 gallons. 

(Everything  filtered.) 

The  reasons  for  using  toast  are:  First,  in  toast- 
ing bread,  the  starch  is  reduced  to  dextrin,  a sugar 
in  which  Bacillus  acidophilus  thrives.  Moreover, 
the  toast  solution  never  filters  entirely  clear,  and 
the  thick  portions  encourage  dense  colonizations, 
which  are  carried  as  such  into  the  cecum. 

The  results  obtained  from  the  administration  of 
catharsis  in  conjunction  with  irrigations  during 
the  clean-up,  and  their  continuation  following  im- 
plantations, are  of  great  value,  as  the  sole  purpose 
is  to  establish  drainage.  This  is  why  catharsis 
with  antiseptic  properties  (such  as  compound 
cathartic  pills)  is  given  during  the  clean-up,  as  it 
helps  to  stimulate  the  general  endocrine  system, 
particularly  the  liver,  softening  the  feces  so  that 
they  can  be  readily  removed  from  the  colon.  The 
unpleasant  effects  of  cathartics  in  conjunction  with 
irrigations  are  relatively  small.  Because  of  the 
large  amount  of  residue  which  follows  the  implan- 
tation of  Bacillus  acidophilus  and  Bacillus  bul- 
garicus,  it  is  necessary  to  give  catharsis,  but  these 

* Difco  is  an  abbreviation  for  Digestive  Ferments  Co. 


Fig.  21. — Bacillus  acidophilus  cultured  in  toast  medium  (stained  by 
Gram’s  method). 


ANTISEPTICS  AND  BACTERIAL  IMPLANTATIONS  149 

cathartics  should  be  nonantiseptic.  When  neces- 
sary, castor  oil,  citrate  of  magnesia,  or  compound 
licorice  powder  may  be  used  to  advantage.  I find 
that  suitable  nonantiseptic  cathartics  are  of  great 
value  in  establishing  permanent  drainage  and 
stimulating  the  colon.  The  catharsis  is  given  in  a 
maximum  dose  and  gradually  reduced  as  indica- 
tions warrant  until  it  can  be  altogether  dis- 
continued. 


CHAPTER  IX 


FECAL  STASIS  AND  ITS  CONSEQUENCES 

Fecal  stasis  a more  accurate  definitive  than  “constipation” 
— Ptosis  primarily  due  to  lack  of  drainage — Vermiform 
muscles  of  the  human  colon  comparable  to  the  muscles  of 
serpents — Muscular  atony  results  from  fecal  stasis — Disten- 
tion and  reversed  peristalsis,  more  remote  results — Alimen- 
tary substances  may  be  absorbed  by  the  blood  stream, 
generating  gases  later  on  expelled  by  the  lungs — Color  and 
odor  of  feces — Recurrence  after  operation  on  intestinal  tract 
often  due  to  fecal  stasis — Vomiting  as  a result  of  pathologic 
conditions  in  the  colon — Position  during  sleep  influences  fecal 
stasis  and  coloptosis — Psychoses  due  to  intestinal  infection — 
Enervation  of  the  colon — Origin  of  pain — Mental  depression 
as  a result  of  digestive  imbalance — Vagotonia — Relief  of  men- 
tal symptoms  by  establishment  of  proper  colonic  drainage. 


CHAPTER  IX 


FECAL  STASIS  AND  ITS  CONSEQUENCES 

Fecal  stasis  a more  accurate  definitive  than  “constipation” 
— Ptosis  primarily  due  to  lack  of  drainage — Vermiform 
muscles  of  the  human  colon  comparable  to  the  muscles  of 
serpents — Muscular  atony  results  from  fecal  stasis — Disten- 
tion and  reversed  peristalsis,  more  remote  results — Alimen- 
tary substances  may  be  absorbed  by  the  blood  stream, 
generating  gases  later  on  expelled  by  the  lungs — Color  and 
odor  of  feces — Recurrence  after  operation  on  intestinal  tract 
often  due  to  fecal  stasis — Vomiting  as  a result  of  pathologic 
conditions  in  the  colon — Position  during  sleep  influences  fecal 
stasis  and  coloptosis — Psychoses  due  to  intestinal  infection — 
Enervation  of  the  colon- — Origin  of  pain — Mental  depression 
as  a result  of  digestive  imbalance — Vagotonia — Relief  of  men- 
tal symptoms  by  establishment  of  proper  colonic  drainage. 


In  some  of  the  conditions  commonly  called 
“constipation,”  the  term  fecal  stasis  is  more  prop- 
erly descriptive  of  that  state  of  intestinal  deficiency 
of  which  the  amount  or  frequency  of  the  bowel 
movements  gives  no  just  indication.  A focus  of 
infection  inducing  a metabolic  imbalance,  which 
is  the  direct  cause  of  an  intestinal  disability,  should 
surely  be  regarded  as  of  itself  a cause  of  disease. 
A focus  of  infection  in  the  digestive  tube  can  ex- 

153 


154 


COLONIC  THERAPY 


cite  or  deplete  the  action  of  the  vagus  and  other 
nerves,  thus  producing  muscular  spasms  or  atony. 
The  result  of  this  combined  imbalance — depend- 
ing upon  the  degree  of  involvement — is  sure  to 
have  a virulent  effect  upon  the  digestive  tube.  A 
person  may  have  but  three  bowel  movements  a 
week,  yet  have  no  fecal  stasis  at  any  point  of  the 
tube;  therefore,  he  enjoys  good  health.  Another 
may  likewise  have  but  three  bowel  movements  a 
week  but  suffers  continual  ill-health  because  of 
fecal  stasis;  still  a third  person  may  have  three 
bowel  movements  a day,  and  yet  display  marked 
fecal  stasis. 

Fecal  stasis  is  always  secondary  to  an  abnor- 
mality, which  may  be  either  a metabolic  imbalance 
or  a mechanical  defect  of  the  tube,  or  perhaps  a 
combination  of  the  two.  Such  a defect  will  in- 
evitably constrict  the  tube  and  cause  blood  stasis. 
To  understand  this  circulatory  constriction  we 
must  bear  in  mind  the  fact  that  the  vascular  sup- 
ply of  the  large  intestine  differs  slightly  from  that 
of  the  ileum.  There  are  fewer  arterial  arches,  and 
there  is  a so-called  marginal  vessel  running  par- 
allel with  the  bowel  and  sending  off  supply 
branches  to  that  organ.  It  is  evident,  therefore, 
that  when  ptosis  occurs,  the  prolapsed  condition 
will  interfere  with  the  distribution  of  the  blood  to 
the  entire  area.  When  blood  stasis  exists  there 
will  be  a general  malnutrition  of  the  affected  area, 


FECAL  STASIS  AND  ITS  CONSEQUENCES  155 

resulting  in  atony,  with  the  inevitable  sequence  of 
fecal  immobility. 

Mechanical  retardation  of  intestinal  residue  is 
undoubtedly  the  cause  of  more  morbidity  and  mor- 
tality than  all  other  physical  defects  combined.  If 
it  were  possible  to  keep  the  digestive  tube  in  per- 
fect condition  there  would  be  little  metabolic  dis- 
turbance. The  functional  organs  would  suffer  no 
disorders,  as  the  metabolic  outlet  would  keep  pace 
with  the  metabolic  intake.  Thus,  life  would  be 
limited  only  by  the  amount  of  physical  endurance 
possessed  by  the  individual,  making  perfectly  pos- 
sible the  attainment  of  a life-span  of  hundreds  of 
years. 

The  primary  cause  of  ptosis  is  nondrainage. 
The  colon,  in  parts,  becomes  overloaded  and  dis- 
eased at  the  same  time,  so  that  it  is  unable  to  prop- 
erly contract  and  empty  itself.  If  the  terminal 
ileum  is  filled  with  feces  and  the  ileocecal  valve  is 
incompetent,  it  is  impossible  for  the  cecum — how- 
ever vigorous — to  raise  itself  and  contract.  The 
muscular  tone  of  the  entire  intestine  will  be  low- 
ered. This  is  also  true  of  the  vermiform  muscles 
of  the  colon,  which  act  much  in  the  same  way  as 
rubber  bands,  keeping  the  muscles  of  the  bowel 
shortened  and  thus  regulating  the  colon’s  power 
of  traction.  The  vermiform  muscles  of  the  human 
intestine  have  a grounding  point  in  the  pelvic 
colon,  so  that  they  are  capable  of  exerting  traction 


156 


COLONIC  THERAPY 


upon  the  cecum  in  such  a way  that  a low-lying 
colon  is  often  drawn  up  into  transient  loops.  Their 
action  may  be  fitly  compared  to  that  of  the  muscles 
of  the  boa-constrictor,  which  must  have  its  tail 
fastened  to  a tree  or  other  grounding  point,  in 
order  to  contract  its  body  in  the  act  of  crushing  its 
prey. 

The  locomotion  of  serpents  is  carried  on  by  un- 
dulations and  archings  of  the  trunk,  all  dependent 
upon  the  action  of  the  vertebral  column  induced 
by  the  vermiform  muscles.  Richard  Owen,  writ- 
ing more  than  sixty  years  ago,  has  given  us  a pic- 
ture of  the  serpent’s  muscular  powers,  never  since 
excelled.  After  describing  the  arching  of  the 
trunk  which  through  flexion  and  extension  enables 
the  reptile  to  progress,  he  tells  us  that  “if  the  act 
of  extension  be  vigorous  and  sudden  and  an 
equivalent  fulcrum  be  afforded  by  the  tail,  the 
whole  body  may  be  carried  forward,  as  by  a leap, 
farther  than  its  own  length.  For  the  saltatory 
motion,  however,  the  mechanism  of  a spiral  spring 
is  commonly  simulated ; the  whole  body  is  bent  into 
a series  of  close-set  coils,  the  sudden  extension  of 
which,  reacting  upon  the  point  of  earth  against 
which  the  tail  presses,  throws  the  serpent  obliquely 
forward  into  the  air.  . . . Serpents  climb  trees  by 
the  same  mechanism  and  actions  as  in  the  first  kind 
of  locomotion  . . . the  tail  has  a prehensile  fac- 
ulty, especially  exercised  by  the  great  constrictors 


0 • 


Fig.  22. — Fecal  smear  (stained  by  Gram’s  method)  made  after  ten 
implantations  of  Bacillus  acidophilus ; the  specimen  shows  a varied 
flora,  with  an  average  growth  of  the  implanted  organism.  Exami- 
nation of  the  first  specimen  taken  from  this  patient  had  shown  a 
predominance  of  Bacillus  coli  and  staphylococci,  with  practically  no 
Bacillus  acidoph ilus. 


FECAL  STASIS  AND  ITS  CONSEQUENCES  157 

while  waiting  for  their  prey.  They  instinctively 
select  a tree  at  the  part  of  the  stream  easiest  of 
access  to  the  thirsty  mammals  of  the  forest,  and 
suspend  themselves  like  a parasitic  creeper,  from 
an  overhanging  branch.  ...  It  is  true  that  the 
serpent  has  no  limbs,  yet  it  can  outclimb  the  mon- 
key, outswim  the  fish,  outleap  the  jerboa,  and, 
suddenly  loosing  the  close  coils  of  its  crouching 
spiral,  it  can  spring  into  the  air  and  seize  a bird 
upon  the  wing.  . . . The  serpent  has  neither  hands 
nor  talons,  yet  it  can  outwresfle  the  athlete,  and 
crush  the  tiger  in  the  embrace  of  its  ponderous 
overlapping  folds.”  Truly  a tribute  to  the  power 
of  the  vermiform  muscles ! 

We  know  that  the  function  of  the  normal  colon 
is  to  extract  and  absorb  fluid.  It  accomplishes 
this  more  rapidly  in  its  proper  physiologic  condi- 
tion than  when  marked  stasis  is  present.  When  a 
healthy  intestine  is  distended  with  solution,  it  has 
the  power  to  expel,  but  where  stasis  exists  there 
will  be  varying  amounts  of  residual  solution  when 
treatment  has  been  completed.  Generally  in  fecal 
stasis  we  find  the  entire  colon  markedly  atonic ; but 
when  a spastic  condition  extends  upward  to  the 
hepatic  flexure,  with  an  angulation  at  this  point, 
we  may  expect  to  find  a distended  ascending  colon 
and  cecum.  When  the  inflammation  and  partial 
obstruction  are  relieved,  however,  we  will  find  no 
atony  of  the  cecum.  Dark  clots  of  mucus,  strips 


158 


COLONIC  THERAPY 


of  membrane  and  long  strips  of  mucus  sometimes 
measuring  three  or  four  feet  in  length  are  occa- 
sionally taken  from  the  colon.  Mucus  of  a very 
light  yellow  is  a symptom  of  enteritis  of  the  ileum. 
The  long  strips  of  mucus  removed  from  the  colon 
are  formed  by  the  invagination  of  the  organ  due 
to  ptosis. 

When  we  find  a fecal  impaction  in  the  colon,  or 
a general  fecal  stasis  together  with  partial  sup- 
pression of  urine,  the  colon  should  be  irrigated, 
caution  being  used  so  as  to  prevent  the  absorption 
of  fluid  before  the  colon  is  clean.  Then  a solution 
containing  a half  pound  of  sodium  phosphate  can 
be  left  in  the  cecum,  which  is  bound  to  cause  the 
colon  to  secrete  a larger  amount  of  fluid.  If 
cathartics  are  used,  we  should  give  those  that  act 
upon  the  colon,  avoiding  salts  and  their  deriva- 
tives, as  they  only  stimulate  the  ileum  to  excrete 
fluid  and  cause  added  distention.  Often  the  ad- 
ministration of  cathartics  will  produce  vomiting  by 
the  regurgitation  of  fluids  into  the  stomach;  and 
in  any  event  will  but  add  to  the  impaction,  instead 
of  relieving  it.  Vomiting  can  he  induced  by  giving 
a hot  enema  if  the  rectum  and  sigmoid  are  spastic, 
as  it  will  cause  reversed  peristalsis  and  nervous 
reflexes.  Vomiting,  nausea,  regurgitation,  and 
belching  may  be  due  to  an  overdistended  cecum,  or 
to  an  impaction  or  obstruction  anywhere  in  the 
colon.  Under  such  circumstances  we  may  expect 


FECAL  STASIS  AND  ITS  CONSEQUENCES  159 

to  find  reversed  or  mixed  ileum  waves.  Artificial 
belching  can  be  produced  in  some  conditions  by 
placing  the  hand  on  the  abdomen  and  pressing 
against  the  ileum  or  duodenum,  or  the  lower  part 
of  the  stomach. 

Sometimes  in  cases  of  intestinal  fecal  impaction 
one  may  find  a brown-coated  tongue  and  a typical 
fecal  odor  to  the  breath,  or  the  tongue  may  be 
covered  with  a thick  white  coat,  and  the  breath  be 
heavy  with  the  odor  of  feces.  This  odor,  however, 
is  not  necessarily  from  the  intestines.  That  such 
an  odor  can  come  from  the  lungs,  I have  proved  by 
a personal  experiment.  Two  hours  after  cleaning 
out  my  colon  by  a thorough  irrigation,  eight  ounces 
of  a solution  of  onion  was  applied  in  the  cecum. 
Though  there  was  no  incompetency  of  the  ileococal 
valve,  for  twenty-four  hours  thereafter  the  odor 
of  onions  was  distinctly  discernible  on  my  breath. 
By  this  simple  demonstration  we  are  able  to  appre- 
ciate the  fact  that  the  cecum  causes  absorption  of 
alimentary  substances  into  the  blood  stream,  the 
gases  from  which  are  later  expelled  by  the  lungs. 
It  does  not,  however,  in  any  way  disprove  the 
assumption  that  feces  may  be  carried  from  the 
colon  into  the  ileum,  or  even  through  the  stomach 
and  esophagus  to  the  mouth,  by  reversed  peristalsis 
and  regurgitation. 

At  times  an  enormous  quantity  of  feces  may  be 
taken  from  the  ileum  and,  in  general,  my  experi- 


160 


COLONIC  THERAPY 


ence  has  shown  that  the  normal  intestinal  residue 
from  different  sections  of  the  digestive  tube  may 
vary  widely  in  color,  odor  and  general  appearance. 
This,  of  course,  depends  largely  upon  the  patho- 
logic conditions  existing,  and  the  amount  and  char- 
acter of  the  food  that  the  individual  patient 
consumes,  but,  so  far  as  the  scale  of  chemical  reac- 
tion is  concerned,  the  conditions  are  not  altered. 
The  residue  from  the  sigmoid  and  rectum  has  a 
marked  fecal  odor  and  is  distinctly  darker  in  color 
than  that  taken  from  the  cecum;  while  that  from 
the  cecum  is  less  offensive  in  odor,  but  darker  in 
color  than  that  from  the  ileum.  Ileum  residue  is 
always  light  in  color;  and  this  light  appearance 
is  not  materially  changed  unless  the  feces  are  de- 
tained in  the  colon. 

An  indication  of  an  atonic  cecum  is  the  removal 
from  that  portion  of  the  tube  of  dark-colored  feces 
of  offensive  odor.  If,  following  the  cleansing  of 
the  cecum,  the  feces  continue  to  be  dark  in  color, 
it  is  a symptom  of  atony  and  fecal  stasis,  for  the 
normal  ileum  residue  is  light  colored  and  not  of 
offensive  odor. 

More  than  once  I have  removed  large  amounts 
of  feces  from  an  impacted  cecum  and  ascending 
colon,  until  all  this  portion  of  the  intestine  was 
clear  of  feces,  only  to  suddenly  discover  that  the 
cecum  was  rapidly  refilling.  On  investigation  I 
found  that  marked  ileal  waves  had  been  caused  by 


Fig.  23. — Fecal  smear  (stained  by  Gram’s  method)  made  three 
months  after  completion  of  a course  of  treatment.  Exceptionally 
abundant  growth  of  Bacillus  acidophilus . At  the  beginning  of  the 
treatment,  the  patient,  aged  sixty-five,  showed  a fecal  flora  in  which 
Bacillus  coli,  streptococci  and  Bacillus  aerogenes  capsulatus  pre- 
dominated, very  few  Gram-positive  bacilli  being  in  evidence. 


FECAL  STASIS  AND  ITS  CONSEQUENCES  161 

the  injection  of  the  solution,  and  removed  from 
the  ileum  great  quantities  of  light-colored  feces 
with  strong  fecal  odor.  It  requires  an  average  of 
ten  days  to  completely  remove  the  feces  from  the 
lower  bowel,  but  when  this  is  accomplished  light- 
colored  feces  may  be  removed  from  the  colon,  and 
the  odor  will  be  much  less  offensive.  The  color 
may  vary,  depending  upon  the  amount  of  bile  and 
other  endocrine  secretions  present,  but  the  impor- 
tant indication  is  that  the  colon  is  cleansed  of  old 
mucus,  putrefactive  membrane  and  feces,  material 
that,  I have  ample  evidence  to  prove,  has  remained 
in  the  colon  for  weeks  or  even  months. 

Postoperative  Recurrences — such  as  are  only  too 
frequent  following  interventions  upon  the  gall- 
bladder or  appendix,  or  the  extirpation  of  a gastric 
or  duodenal  ulcer — are  in  the  great  majority  of 
cases  induced  either  by  a direct  focus  of  infection 
at  the  point  involved ; or  secondarily,  because  fecal 
stasis  has  brought  about  a disturbance  of  the  chem- 
ical balance  of  the  alimentary  tract,  resulting  in 
infection.  Following  any  surgery  upon  the  intes- 
tines the  establishment  of  good  drainage  is  abso- 
lutely essential,  and  without  it  no  lasting  benefit 
from  the  operation  is  possible.  Even  if  recurrence 
of  the  primary  condition  does  not  take  place,  the 
operative  sequelae  may  be  so  severe  as  to  nega- 
tive any  benefit  which  could  be  derived  from  its 
abolition. 


162 


COLONIC  THERAPY 


Vomiting  is  always  the  result  of  stimuli  reach- 
ing certain  centers  in  the  medulla,  but  these  stimuli 
may  be  either  direct  or  indirect.  For  example, 
certain  chemical  substances  act  directly  upon  the 
medullary  center,  while  others  may  take  their 
origin  in  almost  any  part  of  the  body — particularly 
the  pharynx  or  throat,  the  gastric  mucosa,  or  the 
peritoneum.  Irritation  of  the  duodenal  mucosa  is 
especially  liable  to  elicit  vomiting.  An  injury  or 
other  condition  temporarily  interfering  with  the 
stomach  waves  and  thus  allowing  large  quantities 
of  gastric  juice  and  unassimilated  fluid  to  collect, 
will  often  produce  a sudden  attack  of  vomiting, 
causing  intestinal  waves  or  a spasm  of  the  pylorus. 
The  vomiting  is  the  result  of  a convulsive  spasm  of 
the  overdistended  stomach. 

An  inflammatory  condition  of  the  ileum  may 
cause  either  vomiting  or  diarrhea.  In  some  condi- 
tions large  quantities  of  excretion  are  discharged 
from  the  ileum,  producing  inflammation  of  the 
mucosa.  A large  convulsive  inflow  of  contami- 
nated bile  into  the  ileum  frequently  excites  vomit- 
ing. The  emesis  produced  by  overdistention  of 
the  colon  from  giving  an  improper  irrigation  or 
enema  is  accompanied  by  general  cyanosis,  sudo- 
resis, and  extreme  exhaustion.  Nausea,  syncope 
and  semicollapse  may  be  produced  by  stimulating 
the  colon  with  hot  solution,  thus  causing  it  to  expel 
at  one  movement  a mass  of  impacted  feces. 


FECAL  STASIS  AND  ITS  CONSEQUENCES  163 

I know  that  the  habit  of  sleeping  always  on  the 
right  side  is  the  cause  of  a great  deal  of  fecal 
stasis.  I can  tell  by  an  examination  of  an  abdomen 
in  which  coloptosis  coexists  with  cecal  stasis, 
whether  or  not  the  patient  is  a right-side  sleeper, 
as  the  colon  will  be  ptosed  to  the  right  of  the 
median  line,  causing  greater  abdominal  distention 
on  the  right  side  than  on  the  left.  Sleeping  upon 
the  left  side  favors  drainage  of  the  colon,  and  in 
right-sided  ptosis  enlists  the  aid  of  gravity  in 
straightening  kinks.  Everyone  should  form  the 
habit  of  sleeping  alternately  on  the  left  and  right 
sides  in  order  to  maintain  a proper  equilibrium. 
Where  gastro-enteroptosis  or  coloptosis  exists  the 
foot  of  the  bed  should  be  raised  with  blocks  rang- 
ing in  height  from  four  to  six  inches.  Sleeping 
in  this  position  not  only  relieves  the  ptosis,  but  also 
produces  a general  muscular  relaxation  of  the 
body,  thus  tending  to  straighten  kinks  in  the  colon 
and  to  relieve  the  backache  produced  by  ptosis 
as  well  as  the  lameness  and  swelling  of  the  legs 
sometimes  accompanying  this  condition. 

The  relation  of  diseased  conditions  of  the  diges- 
tive tract  to  disturbed  mental  states  is  only  just 
beginning  to  be  appreciated,  but  already  the  mar- 
velous “cures”  of  those  who  had  been  regarded  as 
hopelessly  insane,  simply  by  the  abolition  of  patho- 
logic intestinal  conditions,  has  made  a profound 
impression  upon  the  medical  profession.  That 


164 


COLONIC  THERAPY 


fecal  stasis  may  be  the  basic  cause  of  many  obscure 
psychoses  seems  altogether  probable. 

The  nerves  of  the  alimentary  canal  are  from  the 
hypogastric  plexus.  Different  authors  vary 
slightly  regarding  the  nerve  control  of  the  colon. 
But  it  is  reasonable  to  believe  that  this  portion  of 
the  alimentary  canal  is  largely  controlled  by  means 
of  the  pelvic  plexus,  a subdivision  of  the  hypo- 
gastric. When  the  vagus  is  stimulated,  it  tends  to 
intensify  peristaltic  action  and  increase  the  secre- 
tions of  the  intestinal  glands.  But  the  sympathetic 
or  vegetative  nervous  system  possesses  a certain 
degree  of  independence  of  action  of  the  central 
nervous  system,  the  power  to  functionate  resting 
in  the  plexus  of  nerves  within  the  intestinal  walls. 

The  intestinal  tract,  from  the  stomach  to  the 
rectum,  receives  sympathetic  fibers  from  the  lower 
seven  thoracic  and  upper  three  lumbar  segments 
of  the  cord. 

The  colon  receives  its  stimulation  from  the 
nerves  of  the  pelvic  plexus,  causing  both  a con- 
traction of  the  muscles  of  the  organ,  and  an 
increase  in  its  glandular  activity. 

The  idea  that  pain  felt  in  the  region  of  the 
umbilicus  must  be  attributed  to  the  ileum  is  not 
necessarily  correct.  Nor  is  it  true  that  when  the 
stomach  is  involved  the  seat  of  pain  will  be  in  the 
area  immediately  below  and  to  the  left  of  the  ensi- 
form.  The  impression  that  the  pain  area  between 


FECAL  STASIS  AND  ITS  CONSEQUENCES  165 

the  umbilicus  and  the  pubis  signifies  colon  dis- 
turbance is  also  erroneous. 

In  order  to  trace  pain  to  any  of  the  visceral 
organs,  we  must  first  find  the  affected  organ.  If 
the  stomach  is  ptosed  and  rests  on  the  pubis  and 
certain  gastric  tests  increase  the  pain,  it  is  rea- 
sonable to  infer  that  the  pain  is  in  the  stomach. 
If  the  splenic  flexure  is  very  high,  and  the  colon 
is  distended  with  gas  which  fills  the  area  imme- 
diately below  the  ensiform  on  the  left,  this  pain  is 
caused  by  distention  of  the  colon.  Again,  there 
may  be  an  involvement  of  the  terminal  ileum  com- 
plicated by  ileal  and  mesenteric  ptosis  which  will 
produce  a pain  in  the  vicinity  of  the  umbilicus  and 
pubes. 

The  pain  so  commonly  attributed  to  an  inflamed 
appendix,  which  is  often  felt  in  the  right  lower 
quadrant  of  the  abdomen,  is  not  necessarily  an 
involvement  of  the  appendix,  for  severe  pain  in 
that  region  may  be  produced  by  an  infected  or  dis- 
tended cecum,  or  marked  disturbance  in  the  ter- 
minal ileum. 

When  we  take  into  consideration  the  network 
of  nerves  in  the  abdominal  cavity,  and  the  extreme 
ptosis  of  one  or  more  organs  not  infrequently 
found,  it  is  easily  comprehensible  how  often  it  may 
be  impossible  to  decide  on  the  point  of  involve- 
ment by  the  localization  of  the  pain.  Pain  on  one 
side  of  the  body  is  not  infrequently  a transference 


166 


COLONIC  THERAPY 


of  the  sensory  impulse  on  that  side  to  the  efferent 
sensory  neurons  on  the  other  side,  or  a reflex  to 
any  other  part  of  the  abdominal  cavity. 

It  is  not  at  all  unusual,  however,  to  find  cases 
of  functional  intestinal  derangement  where  the 
mental  depression  is  so  severe  as  to  be  wholly  be- 
yond the  patient’s  voluntary  control,  constituting 
an  acute  mental  disturbance  which  is  comparable 
in  the  mental  sphere  to  a severe  physical  pain  in 
the  sphere  of  sensation.  Nervous  impulses  arising 
in  the  abdominal  cavity  and  passing  to  the  brain 
along  the  vagal  or  sympathetic  nerve  paths  have 
the  power  to  directly  disturb  the  mental  condition 
on  which  the  sense  of  well-being  is  dependent,  and 
of  giving  rise  to  an  acute  mental  distress  which 
represents  the  physical  pain  which  the  subject 
would  have  felt  if  the  afferent  impulse  causing 
the  stimulation  had  been  transferred  from  the  vagal 
or  sympathetic  to  the  sensory  nerves. 

The  fact  that  many  mental  disturbances  are 
really  due  to  functional  derangement  in  the  ali- 
mentary canal  is  demonstrable  clinically  by  the 
fact  that  these  conditions  yield  to  treatment  that 
lessens  the  amount  of  bacterial  activity  in  the  tube. 
Patients  suffering  from  physical  disability — 
various  forms  of  nervous  depression  and  excita- 
tion, and  general  endocrine  imbalance — often 
manifest  mental  disturbance  as  well.  Such  a 


FECAL  STASIS  AND  ITS  CONSEQUENCES  167 

syndrome  has  been  postulated  under  the  popular 
diagnosis  of  vagotonia. 

This  condition  is  well  illustrated  by  a patient 
sent  to  me  for  treatment  who  was  subject  to  un- 
controllable crying  spells  arising  without  apparent 
reason.  These  attacks  of  mental  depression  would 
last  for  several  days,  during  which  time  she  would 
lock  herself  in  a room,  refusing  food  and  medical 
assistance  because  on  previous  occasions  medicine 
had  failed  to  relieve  her  distress.  On  examination, 
a large  loop  in  the  colon  at  the  hepatic  flexure  was 
detected.  When  a great  quantity  of  feces  had 
been  removed  from  this  loop,  and  it  was  kept  clean 
by  daily  antiseptic  treatments,  improvement  was 
so  marked  that  the  patient  was  elated.  Unfor- 
tunately before  the  loop  was  straightened  the  pa- 
tient was  obliged  to  temporarily  discontinue  her 
treatments,  and  later  returned,  complaining  that 
she  was  again  unable  to  control  her  emotions.  But 
when  once  more  the  detained  feces  were  removed 
from  the  loop,  immediate  relief  of  the  distressing 
symptoms  took  place. 

Hypotonia  is  a common  pathologic  condition  of 
the  colon  often  involving  the  ileum,  and  is  gen- 
erally found  to  coexist  with  coloptosis.  It  is  often 
so  marked  as  to  simulate  complete  atonia. 

When  vagotonia  of  the  ileum  coexists  with 
hypotonia  of  the  colon,  it  often  produces  severe 
abdominal  pain  during  the  act  of  defecation. 


168 


COLONIC  THERAPY 


I have  had  many  cases  sent  to  me  for  treatment 
where  the  reflex  contraction  caused  attacks  of 
vasomotor  angina  pectoris.  These  patients  were 
permanently  cured  by  the  establishment  of  proper 
colonic  drainage,  and  in  other  interesting  cases, 
clearly  due  to  nervous  disturbance  arising  in  the 
alimentary  canal,  the  correction  of  abnormal 
colonic  conditions  brought  prompt  and  permanent 
relief  of  all  mental  symptoms.  Frequently  men- 
tal depression  or  excitation  had  been  the  only  com- 
plaint, no  symptoms  referable  to  the  intestinal 
tract  having  ever  been  manifested. 


CHAPTER  X 

THE  HUMAN  MACHINE 

The  “chronic  abdomen” — Hutchison’s  delineation — Ade- 
quate colonic  drainage  a cure  for  most  uncatalogued  abdominal 
ills — Operation  often  avoided  by  abolishing  fecal  stasis  and 
establishing  a properly  balanced  fecal  flora — Medicinal  treat- 
ment unavailing  without  previous  “cleaning  out” — Abdominal 
asthenia — The  effect  of  corset  wearing — Alcoholic  indulgence 
vs.  muscular  atrophy — Injurious  effects  of  a saccharide  diet — 
Campbell’s  views — The  necessity  for  moderation  and  uniform- 
ity in  eating — The  care  of  the  human  machine. 


CHAPTER  X 


THE  HUMAN  MACHINE 

The  “chronic  abdomen” — Hutchison’s  delineation — Ade- 
quate colonic  drainage  a cure  for  most  uncatalogued  abdominal 
ills — Operation  often  avoided  by  abolishing  fecal  stasis  and 
establishing  a properly  balanced  fecal  flora— Medicinal  treat- 
ment unavailing  without  previous  “cleaning  out”- — Abdominal 
asthenia — The  effect  of  corset  wearing — Alcoholic  indulgence 
vs.  muscular  atrophy — Injurious  effects  of  a saccharide  diet — 
Campbell’s  views — The  necessity  for  moderation  and  uniform- 
ity in  eating — The  care  of  the  human  machine. 


Aside  from  the  cases  of  manifest  alienation  men- 
tioned in  the  last  chapter,  the  practice  of  every 
physician — be  he  a “specialist  within  a specialty” 
or  a family  doctor — is  burdened  with  a class  of 
patients  which  I was  at  a loss  to  describe  ade- 
quately, until  a short  time  ago  my  eye  fell  upon 
an  address  delivered  by  Dr.  Robert  Hutchison  32 
before  the  Clinical  Society  of  Manchester,  Eng- 
land, which  was  printed  in  the  British  Medical 
Journal.  So  perfectly  has  this  English  medical 
man  painted  the  picture  I have  in  mind  that  I shall 
take  the  liberty  of  reproducing  verbatim  much  of 
what  he  has  to  say  concerning  the  victims  of  the 
“chronic  abdomen.” 


171 


172 


COLONIC  THERAPY 


“Our  surgical  colleagues  describe  a condition 
which  they  speak  of,  in  their  clinical  slang,  as  the 
‘acute  abdomen.’  There  is,  however,  another  con- 
dition more  familiar  to  the  physician  which  may  be 
designated  with  equal  propriety  the  ‘chronic  abdo- 
men,’ and  if  the  one  is,  as  we  are  told,  a catastrophe, 
the  other  is  certainly  a conundrum. 

“The  subject  of  the  chronic  abdomen  is  usually 
a woman,  generally  a spinster,  or,  if  married, 
childless  and  belonging  to  what  are  commonly 
termed — rather  ironically  nowadays — the  ‘com- 
fortable’ classes.  To  such  a degree,  moreover,  do 
her  abdominal  troubles  colour  her  life  and  person- 
ality that  we  may  conveniently  speak  of  her  as  an 
‘abdominal  woman.’  An  abdominal  man,  on  the 
other  hand,  is  by  comparison  a rare  bird,  and  when 
caught  has  a way  of  turning  out  to  be  a Jew — or  a 
doctor. 

“The  symptoms  of  the  chronic  abdomen  are 
many,  various,  and  ever-renewed.  Some  of  them 
refer  directly  to  the  abdominal  organs,  others  are 
of  a more  remote  and  general  character ; but,  what- 
ever they  are,  they  are  always  described  with  great 
prolixity  and  in  minute  detail.  Amongst  those 
most  commonly  complained  of  are  abdominal  aches 
and  pains  of  various  sorts  and  in  various  places, 
but  especially  in  the  right  iliac  fossa.  Instead  of 
actual  pain  the  patient  may  speak  of  a ‘raw  feeling 
inside,’  or  of  ‘an  indescribable  sensation  in  the 


THE  HUMAN  MACHINE 


173 


stomach,’  or  of  a ‘dragging.’  Constipation  of 
greater  or  less  degree  almost  always  figures  promi- 
nently in  the  list  of  symptoms,  and  flatulence  is 
also  frequent.  Amongst  the  commoner  remote 
symptoms  one  finds  a feeling  of  general  weakness 
or  ‘exhaustion’  (especially  after  an  action  of  the 
bowels),  ‘mental  and  physical  torpor,’  ‘inability  to 
think,’  ‘a  poisoned  feeling,’  and  ‘neuralgic  pains  all 
over.’  Headaches  and  insomnia  are  also  very  fre- 
quent, and  a great  many  patients  complain  of 
undue  susceptibility  to  cold  and  of  a constant 
catarrh  in  the  throat. 

“If  one  inquires  of  a patient  with  a fully  de- 
veloped chronic  abdomen  how  her  lamentable  state 
has  been  arrived  at,  it  will  be  found  that  the  proc- 
ess of  evolution  is  fairly  constant.  These  sufferers 
are  very  fond  of  presenting  anyone  whom  they 
may  consult  with  a full  record  of  their  previous 
medical  history  and  experiences.  . . . 

“The  road  to  chronic  abdominalism  is  paved 
with  operations.  The  usual  sequence  seems  to 
be  this:  the  patient  begins  by  complaining  of  pain 
or  discomfort  in  the  right  iliac  fossa,  for  the  relief 
of  which  the  appendix  is  removed.  For  a few 
months  she  is  better.  (It  is  characteristic  of  the 
disease  that  almost  any  new  treatment,  and  espe- 
cially any  operation,  produces  benefit  for  a time.) 
Soon,  however,  her  symptoms  return.  This  is  put 
down  to  ‘adhesions,’  and  another  operation  is  per- 


174 


COLONIC  THERAPY 


formed  to  remedy  these,  with  the  same  result  as 
the  first.  Warming  to  his  work,  the  surgeon  un- 
dertakes bolder  and  yet  bolder  proceedings ; a 
complete  hysterectomy  is  probably  carried  out  or 
some  short-circuiting  device,  or  the  colon  is  fixed, 
or  even  partially  removed,  but  still  the  patient  is 
not  cured  of  the  pains,  whilst  the  state  of  the 
nervous  system  has  steadily  worsened. 

“It  is  interesting  to  note  at  this  point  how  medi- 
cal history  repeats  itself.  Writing  in  the  eighties 
of  last  century  on  the  abuse  of  gynaecological 
operations  in  the  treatment  of  visceral  neurosis, 
Sir  Clifford  Allbutt  said  of  the  abdominal  woman 
of  that  day: 

“ ‘She  is  entangled  in  the  net  of  the  gynaecol- 
ogist, who  finds  her  uterus,  like  her  nose,  is  a 
little  on  one  side,  or  again,  like  that  organ,  is 
running  a little,  or  it  is  as  flabby  as  her  biceps, 
so  that  the  unhappy  viscus  is  impaled  upon  a 
stem,  or  perched  upon  a prop,  or  is  painted  with 
carbolic  acid  every  week  in  the  year  except  dur- 
ing the  long  vacation  when  the  gynaecologist 
is  grouse-shooting  or  salmon-catching,  or  lead- 
ing the  fashion  in  the  Upper  Engadine:  Her 

mind,  thus  fastened  to  a more  or  less  nasty 
mystery,  becomes  newly  apprehensive  and  phy- 
sically introspective,  and  the  morbid  chains  are 
riveted  more  strongly  than  ever.  Arraign  the 


THE  HUMAN  MACHINE 


175 


uterus  and  you  fix  in  the  woman  the  arrow  of 
hypochondria,  it  may  be  for  life.’  On  Visceral 
Neurosis,  Goulstonian  Lectures,  1884. 

“Substitute  ‘surgeon’  for  ‘gynaecologist’  and 
‘appendix’  for  ‘uterus’  and  the  parallel  is  com- 
plete. At  that  time  the  uterine  organs  were  the 
scapegoat  of  the  abdomen;  now  it  is  the  appendix 
— if,  indeed,  it  is  not  already  the  teeth  or  the 
tonsils. 

“Meanwhile,  and  between  the  more  dramatic 
entries  and  exits  of  the  surgeon,  the  physician  has 
not  been  idle.  The  patient  has  been  thoroughly 
‘investigated,’  possibly  at  a ‘team-work’  clinic;  she 
has  certainly  been  provided  with  an  x-ray  picture- 
book  of  her  entire  alimentary  canal;  her  teeth  have 
been  extracted  and  her  tonsils  excised ; her  motions 
have  been  analyzed  by  a biochemist  and  her  mind 
by  a psycho-analyst;  she  has  had  several  rest  cures; 
she  has  been  given  prolonged  courses  of  vaccines, 
of  intramuscular  tonic  injections,  of  intestinal 
antiseptics,  and  of  endocrines;  she  has  been  fed  on 
sour  milk  or  minced  beef  or  raw  vegetables;  she 
has  experienced  various  forms  of  massage,  has 
been  subjected  to  the  latest  kinds  of  electrical  cur- 
rent, and  has  had  her  colon  repeatedly  washed  out 
at  Plombieres  or  Harrowgate. 

“In  a word,  she  has  run  the  whole  gamut  of 
‘modern’  therapy,  has  submitted  to  every  ‘stunt’ 


176 


COLONIC  THERAPY 


and  conformed  to  every  fad — but  is  none  the  bet- 
ter. And  just  as  she  can  only  escape  the  atten- 
tions of  the  surgeon  when — as  Sir  Clifford  Allbutt 
said  of  the  gynaecologist — he  is  ‘grouse-shooting 
or  salmon-catching  or  leading  the  fashion  in  the 
Upper  Engadine,’  so  she  is  only  at  peace  from  the 
physician  when  the  latter  is  recruiting  his  ex- 
hausted energies  by  a short  holiday  at  an  inex- 
pensive seaside  resort. 

“On  examination  of  a fully  developed  case  of 
the  chronic  abdomen  one  will  find  that  it  has  both 
a physical  and  a mental  aspect,  and  that  the  latter 
is  often  the  more  important  of  the  two. 

“Physically  the  patient  is  undernourished  and 
sallow.  To  use  an  abominable  term  current  at  the 
moment,  she  looks  ‘toxic.’  The  abdomen  is  of 
visceroptotic  shape  and  the  surface  criss-crossed 
with  scars,  the  signs-manual  of  the  surgeons  who 
at  one  time  or  another  have  conducted  exploring 
expeditions  into  the  interior.  The  stomach  is 
dropped  and  splashy  and  the  right  kidney  more 
or  less  movable;  there  is  tenderness  at  various 
points  over  the  colon.  Constipation  will  probably 
be  obstinate,  and  the  motions  usually  show  the 
presence  of  mucus  or  even  membranes. 

“The  mental  side  of  the  case  is  more  difficult  to 
analyse.  There  is  notable,  in  the  first  place,  a 
general  discontent,  ‘disgruntlement,’  and  peevish- 
ness, added  to  which  is  an  intense  egotism  which 


THE  HUMAN  MACHINE 


177 


leads  the  patient  to  regard  herself  and  her  symp- 
toms as  of  the  utmost  importance.  In  a play 
called  The  Mollusc , which  appeared  some  years 
ago,  this  aspect  of  the  abdominal  woman  was  ad- 
mirably depicted,  but  I noticed  that  all  my  patients 
of  this  type  who  went  to  see  it  simply  remarked, 
‘How  absolutely  like  Mrs.  So-and-so!’  None  of 
them  recognized  the  Mollusc  as  herself.  Needless 
to  say,  the  patient  is  also  intensely  introspective 
and  hypochondriacal.  She  studies  and  catalogues 
her  symptoms  with  minute  care,  and  is  expert  in  a 
knowledge  of  the  action  of  drugs  and  a connoisseur 
of  doctors  and  ‘specialists.’ 

“ ‘She  has  seen  heaps  of  specialists,’  a doctor 
wrote  to  me  of  a typical  example,  ‘and  no  doubt 
will  continue  to  do  so.  You  will  be  amused  and 
interested  to  hear  that  she  promptly  went  off  to 
another  specialist  after  seeing  you.’ 

“The  operation  habit  has  often  a strong  hold  on 
her.  Added  to  all  this,  and  most  trying  of  all,  is 
an  intense  craving  for  sympathy  which  must  be 
satisfied  at  all  costs,  and  it  is  noteworthy  that  there 
is  usually  someone  in  her  entourage  who  is  always 
ready  to  supply  the  need.  Sometimes  an  unmar- 
ried daughter  is  the  victim;  sometimes  it  is  an 
over-devoted  husband. 

“Her  incessant  demand  for  sympathy  and  un- 
derstanding makes  the  abdominal  woman  a veri- 


178 


COLONIC  THERAPY 


table  vampire,  sucking  the  vitality  of  all  who  come 
near  her.  Half  an  hour  with  her  reduces  her  doctor 
to  the  consistence  of  ‘a  piece  of  chewed  string,’  and 
is  more  exhausting  to  him  than  all  the  rest  of  his 
daily  visits  put  together,  for  she  is  always  discov- 
ering fresh  symptoms,  will  not  admit  any  improve- 
ment in  her  condition,  and  has  an  objection  to 
everything  that  is  proposed.  Crabbe  must  have 
had  her  in  mind  when  he  wrote  of  the  patients — 

“ ‘Who  with  sad  prayers  the  weary  doctor  tease 
To  name  the  nameless  ever  new  disease.’ 


“Fortunately,  however,  she  never  sticks  to  one 
doctor  long,  but  is  always  rushing  off  after  fresh 
advice,  and  her  nurses  can  always  be  changed  at 
short  intervals;  if  they  were  not,  they  would  go 
mad. 

“When  one  comes,  then,  to  analyse  a case  of  the 
chronic  abdomen,  it  is  found  to  consist  on  the 
physical  side,  of  a state  of  visceroptosis  along, 
usually,  with  a greater  or  less  degree  of  muco- 
membranous  colitis,  and,  on  the  mental  side,  of 
that  morbid  psychological  state  which  was  sketched 
above.  But  now  comes  the  conundrum.  How  can 
the  physical  basis  produce  the  multiform  symp- 
toms of  which  the  patient  complains,  and  wdiat  is 
its  relation  to  the  mental  side  of  the  picture? 

“It  is  common  knowledge,  of  course,  that  many 
women  have  pronounced  visceroptosis  without  be- 


THE  HUMAN  MACHINE 


179 


ing  much  affected  by  it  either  physically  or  men- 
tally. Why,  then,  do  these  particular  patients 
appear  to  suffer  so  much?  Again,  what  part  does 
muco-membranous  colitis  play?  It  is  true  that  one 
rarely  sees  a sufferer  from  that  disease  who  does 
not  exhibit  in  greater  or  less  degree  the  mental 
characteristics  of  chronic  abdominalism,  but  what 
is  the  relation  of  the  one  to  the  other?  Does  the 
colitis  affect  the  mind,  or  is  it  the  other  way  round? 
I need  not  remind  you,  of  course,  that  there  is  a 
school  of  thought  which  would  attribute  all  the 
remote  physical  symptoms  of  chronic  abdominal- 
ism, and  presumably  the  mental  symptoms  also, 
to  ‘auto-intoxication.’  This  doctrine  has  been  so 
much  discussed  in  recent  years  that  I do  not  pro- 
pose to  weary  you  with  a further  consideration  of 
it;  but  although  there  may  be  an  element  of  self- 
poisoning in  some  of  these  cases,  I feel  bound  to 
express  the  opinion  that  it  will  not  account  for  all 
the  symptoms.  Nor  have  I any  new  theory  to 
offer.  There  remains,  when  all  is  said  and  done,  a 
good  deal  of  mystery  about  the  chronic  abdomen, 
and  it  needs  further  study — especially,  perhaps, 
from  the  psychological  side  and  from  the  stand- 
point of  the  relation  of  the  vegetative  nervous  sys- 
tem to  the  emotions.  . . . 

“What  is  to  be  desired  is  something  which  will 
dislocate  the  patient’s  mind  from  its  perpetual 
revolution  round  her  umbilicus  and  set  it  open  to 


180 


COLONIC  THERAPY 


wider  horizons.  The  war  cured  some,  and  loss  of 
fortune  and  bereavement  have  cured  others;  but 
these  are  drastic  remedies  which  it  is  not  within 
our  power  to  prescribe.  Suffragettism  undoubt- 
edly was  the  salvation  of  some  abdominal  women, 
but  the  suffragettes  are  now  experiencing  the 
tragedy  of  fulfilled  ambition,  and  probably  many 
of  them  have  relapsed.  Marriage,  and  the  advent 
of  a child — even  an  adopted  one — are  often  potent 
remedies,  and  the  fancy  religions — Christian 
Science,  Theosophy,  Spiritualism,  and  so  forth — 
may  be  ways  of  escape.  One  of  my  patients,  an 
ex-nurse  (and  ex-nurses  furnish  the  most  malig- 
nant types  of  the  chronic  abdomen),  once  con- 
sulted a palmist,  who  after  looking  at  her  hand 
said : ‘If  I were  your  husband  I would  take  a stick 
to  you!’  The  advice  was  sound,  and  might  often, 
perhaps,  be  effective. 

“I  confess,  therefore,  to  some  feeling  of  despair 
as  regards  the  treatment  of  the  more  advanced 
cases  of  the  chronic  abdomen,  and  on  the  whole  I 
am  inclined  to  think  that  the  less  one  has  to  do 
with  them  the  better,  both  for  one’s  peace  of  mind, 
and  one’s  professional  reputation.  Yet,  unfor- 
tunately, these  cases  are  likely  to  increase  in  the 
future,  for  as  civilization  gets  more  complex,  as 
fewer  women  in  the  upper  classes  marry,  or,  being 
married,  have  fewer  and  fewer  children,  all  the 
factors  which  favor  the  development  of  chronic 


THE  HUMAN  MACHINE  181 

abdominalism  will  be  more  intense.  It  is  a bleak 
prospect.” 

It  is  noticeable  that  the  bleakness  of  Dr.  Hutchi- 
son’s “prospect”  is  offered  no  alleviation  by  the 
proper  correction  of  disordered  conditions  in  the 
digestive  tube.  Though  he  mentions  analysis  of 
the  chronic  abdominalist’s  “motions”  by  a bio- 
chemist ; and  that  she  “has  had  her  colon  repeatedly 
washed  out  at  Plombieres  or  Harrowgate,”  there 
is  no  evidence  that  the  “washing  out”  as  practiced 
at  the  health  resorts  he  mentions  is  in  any  respect 
thorough  or  adequate. 

Had  the  cecum  been  reached  and  treated  as  it 
should  be,  every  symptom  he  describes  with  such 
exquisite  precision  would  have  disappeared. 

A neurotic  is  the  product  of  a disease  that  the 
physician  is  not  able  to  locate  and  the  patient  un- 
able to  describe.  The  condition  that  Dr.  Hutchi- 
son pictures  is  found  not  alone  among  single  or 
childless  women,  but  likewise  in  married  women, 
mothers,  men,  and  even  little  children,  irrespective 
of  age  or  intelligence.  A careful  examination 
and  the  results  of  adequate  treatment  will  prove 
that  all  these  disturbances  are  caused  by  some  in- 
testinal infection.  The  majority  of  the  men  and 
women  I have  treated  and  helped  to  cure  during 
the  past  ten  years  were  in  the  condition  described 
by  Dr.  Hutchison.  Of  the  two  hundred  and 
eighty  patients  now  under  treatment  no  less  than 


182 


COLONIC  THERAPY 


one  hundred  and  seventy  are  postoperative  cases. 
In  the  last  few  years,  a great  increase  in  those  com- 
ing after  gall-bladder  operations  or  gastro- 
enterostomy has  been  noticeable.  Those  who  have 
undergone  appendectomy  and  hysterectomy  are  in 
about  the  same  proportion,  but  the  number  of 
tonsillectomy  subjects  is  rapidly  increasing. 

The  reason  that  the  results  of  the  great  majority 
of  appendectomies  are  unsatisfactory  or  altogether 
negative  is  that  the  extirpation  of  the  appendix 
removes  only  a part  of  the  diseased  condition. 
The  cecum — the  original  seat  of  the  trouble — re- 
mains unaffected.  The  slight  benefit  generally 
obtained  after  operation  is  the  result  of  the  pre- 
operative preparation  of  the  alimentary  canal  and 
the  treatment  by  diet  and  other  therapeutic  meas- 
ures following  the  operation.  Many  patients  re- 
ferred to  me  with  a tentative  diagnosis  of  appendi- 
citis, were  later — after  colonic  treatment — given  a 
final  diagnosis  by  the  same  physician  of  fecal  stasis 
of  the  terminal  ileum  and  cecum.  And — most  in- 
teresting of  all — these  very  patients  were  so  com- 
pletely restored  to  health  by  the  colonic  irrigation 
and  coincident  medical  treatment  that  operation 
of  any  kind  was  found  wholly  unnecessary.  This 
gives  me  an  opportunity  to  emphasize  once  more 
the  chief  value  of  the  system  of  treatment  hereto- 
fore outlined.  In  practically  every  diseased  con- 
dition, no  matter  what  therapy  the  attending  pliy- 


THE  HUMAN  MACHINE 


183 


sician  may  contemplate,  thorough  colonic  irriga- 
tion, the  establishment  of  proper  systemic  drainage 
and  the  cultivation  of  a normally  balanced  fecal 
flora  will  make  possible  the  successful  application 
of  remedial  measures,  leading  to  more  satisfactory 
results  than  can  be  obtained  by  any  other  means. 

Sympathy,  however,  is  with  the  surgeon,  despite 
his  demonstrated  inability  to  cure  an  intestinal  in- 
fection by  removing  an  anatomical  part.  The 
physician  has  had  his  innings,  and  must  yield  the 
field  to  the  surgeon.  For  generations  he  has  at- 
tributed all  intestinal  disturbance  to  “biliousness,” 
“constipation”  and  varying  types  of  colitis,  which 
are  wholly  inadequate  descriptions  of  the  condi- 
tions actually  existing.  He  has  prescribed  medica- 
ments which  give  merely  temporary  relief,  yet  had 
these  remedies  been  administered  after  proper 
intestinal  drainage  had  been  established,  they 
would  have  been  powerful  agents  in  restoring  the 
patients  to  perfect  health.  Many  a good  remedy 
has  been  applied  to  a condition  that  did  not  exist, 
and  a remedy  highly  effective  in  one  condition  may 
be  of  no  use  in  another  very  similar;  for  example, 
the  use  of  an  abdominal  belt  for  a postoperative 
ventral  hernia.  A belt  is  a good  appliance  to  sup- 
port the  abdominal  wall,  but  if  put  on  with  the  idea 
of  holding  up  the  stomach,  kidney,  or  any  other 
viscus,  it  is  not  alone  rendered  wholly  ineffective 
because  of  the  anatomical  structure  and  the  re- 


184 


COLONIC  THERAPY 


spiratory  movements  of  the  diaphragm  and  ab- 
domen, but  it  also  has  a tendency  to  cause  atrophy 
of  the  abdominal  muscles.  A similar  condition  of 
muscular  atrophy  is  frequently  found  in  corseted 
women. 

The  president  of  an  association  of  mothers  or- 
ganized to  dash  the  wine  glass  from  the  bps  of  the 
alcohol-soaked  males — who  by  lowering  their  own 
powers  of  resistance,  and  thus  permitting  disease 
to  destroy  their  vitals  are  the  cause  of  so  much 
misery  and  the  bringing  of  imperfect  children  into 
the  world, — this  worker  in  a noble  and  spectacular 
cause,  was  sent  to  me  for  treatment.  Her  height 
was  five  feet  four  and  at  the  age  of  forty  she 
weighed  one  hundred  and  eighty  pounds.  The 
usual  appendectomy  scar  was  present,  together 
with  that  of  a suprapubic  hysterectomy,  which  had 
been  performed  following  the  birth  of  her  one  child 
who  had  died  at  the  age  of  six  months,  cause  not 
stated.  This  patient  was  suffering  from  gastro- 
enteroptosis  and  abdominal  asthenia,  the  condition 
being  so  marked  that  as  she  moved  “off  center” 
while  lying  on  her  back,  her  abdomen  surged 
visibly  from  side  to  side.  The  amount  of  putre- 
factive residue  which  I was  able  to  remove  from 
her  colon  offered  an  ample  explanation  for  all  the 
headaches,  dizziness  and  nervousness  of  which  she 
complained.  When  I suggested  that  her  physician 
prescribe  a low  protein  diet,  and  that  she  stop 


THE  HUMAN  MACHINE 


185 


wearing  corsets  she  gave  the  regulation  answer. 
“I  eat  very  lightly,  and  my  corset  is  worn  perfectly 
loosely.  Besides,  if  I leave  it  off,  my  back  aches.” 
No  amount  of  persuasion  would  change  her  mind; 
she  insisted  upon  retaining  her  corset.  It  would 
have  been  far  less  difficult  to  persuade  a drunkard 
to  ignore  the  bottle.  However,  under  treatment 
her  intestinal  condition  improved;  her  headaches 
and  dizziness  disappeared;  her  blood  pressure  rose 
from  90  to  130;  her  weight  was  reduced  by  twenty 
pounds.  Though  it  is  now  four  years  since  she  was 
under  my  care  she  is  still  in  comparatively  good 
health,  and  still  wears  corsets,  while  I am  unable 
to  get  wine.  Most  men  are  not  drunkards,  but 
most  women  are  corset-wearers.  As  abdominal 
asthenia  is  found  as  frequently  in  virgins  as  in 
mothers,  the  cause  cannot  be  weakness  of  the  pel- 
vic diaphragm  following  the  trauma  incident  to 
childbirth;  and  as  it  is  rarely  found  in  men,  it 
seems  reasonable  to  attribute  it  to  corset  wearing. 

Strong  alcoholic  drinks  are  injurious,  light  wine 
and  beer  in  moderation  are  tonics  and  less  injuri- 
ous than  coffee,  which  is  a drug,  and  to  some  who 
drink  it,  a poison.  A corset  prevents  the  normal 
abdominal  movement  of  the  wearer,  and  causes 
atrophy  of  the  abdominal  and  pelvic  muscles,  thus 
destroying  a naturally  beautiful  form,  inducing 
abdominal  asthenia  and  general  pelvic  disturb- 
ance; produces  unhealthy  mothers  and  childless 


186 


COLONIC  THERAPY 


women;  and  causes  far  more  disease  and  suffering 
than  alcohol  ever  has.  I should  vastly  enjoy 
“getting  even  with”  those  who  are  responsible  for 
the  loss  of  my  wine,  and  at  the  same  time  improve 
the  health  of  the  coming  generation  by  forcibly 
separating  the  women  from  their  corsets. 

It  is  an  open  question  whether  or  not  we  made 
a good  trade  in  substituting  ice-cream  soda  and 
candy — records  show  that  the  United  States  eats 
more  sugar  than  any  other  people — for  light  wines 
and  beer.  This  substitution  has  entirely  altered 
our  diet,  for  without  prohibition  a greater  portion 
of  our  population  would  drink  beer  or  wine  and 
eat  cheese  and  crackers  and  the  various  salads. 
They  would  consume  less  food,  and  that  food 
would  be  of  an  entirely  different  character  from 
what  is  consumed  at  present.  Our  livers  are 
capable  of  harboring  a great  deal  of  sugar;  but 
what  becomes  of  the  surplus  sugar  we  might  be 
greatly  interested  to  know.  From  my  experience 
at  least,  it  is  certainly  not  producing  a great 
growth  of  acidophilus  in  the  average  intestinal 
canal,  and  it  is  everywhere  apparent  that  we  are 
all  getting  fat. 

That  I am  not  alone  in  this  opinion  is  evident 
in  many  quarters.  Campbell,33  an  English  writer, 
contributing  to  a system  of  diet  and  dietetics  has 
this  to  say  in  regard  to  the  effect  of  a highly  sac- 
charide diet: 


THE  HUMAN  MACHINE 


187 


“ ‘Meat’  and  other  kinds  of  animal  food  are 
often  credited  with  being  the  cause  of  ill-health 
when  the  saccharide  constituents  of  the  diet  are 
equally,  if  not  more,  responsible,  for  in  many  cases 
in  which  improved  health  follows  upon  the  curtail- 
ment of  animal  food,  an  equally  good,  perhaps 
even  a better,  result  could  he  obtained  by  cutting 
down  the  saccharides.  Again,  it  is  often  contended 
that  centenarians  owe  their  great  age  in  large 
measure  to  the  fact  of  their  having  always  eaten 
sparingly  of  meat,  whereas  it  will  generally  be 
found  that  they  have  been  just  as  moderate  in 
regard  to  the  other  items  of  their  food — indeed 
that  they  have  observed  moderation  in  most  things. 

“The  fact  that  right  up  to  the  beginning  of  the 
agricultural  period  man’s  supply  of  sugar  was 
scanty,  whereas  during  it,  and  especially  within 
recent  times,  it  has  been  enormously  increased, 
suggests  that  ill-health  may  often  result  from  its 
excessive  consumption.  Experience  proves  this  to 
be  the  case;  we  are  often  able  to  effect  great  im- 
provement in  health  simply  by  reducing  the  intake 
of  sugar. 

“The  facts  that  within  recent  times  the  supply 
of  vegetable  food  has  increased  more  than  that  of 
animal  food,  that  the  softness  of  modern  vegetable 
food  favors  its  excessive  consumption,  and  that 
enormous  quantities  of  pure  sugar  are  accessible, 
prepare  us  for  the  conclusion  that  the  neo-man  is 


188 


COLONIC  THERAPY 


more  likely  to  suffer  from  an  excess  of  highly 
saccharide  vegetable  food  than  from  an  excess  of 
animal  food. 

“The  fact  that  during  the  entire  period  of  his 
evolution  from  the  simian,  man’s  vegetable  food 
was  eaten  raw,  whereas  at  the  present  day  almost 
the  whole  of  it  is  cooked,  suggests  that  good  may 
often  result  from  increasing  the  proportion  of  raw 
vegetable  foods,  such  as  apples,  bananas,  nuts,  and 
salads,  all  of  which  should  be  thoroughly  mas- 
ticated. 

“The  fact  also  that  our  vegetable  food  is  so  very 
much  more  concentrated  now  than  it  was  in  the 
time  of  our  ancestors  suggests  the  advisability  of 
including  a due  proportion  of  bulky  vegetable 
foods  in  our  dietary. 

“Before  the  period  of  fixed  agriculture  the 
quantity  of  food  was  not  in  excess  of  physical  re- 
quirements, for  though  primitive  man  doubtless 
had  his  bouts  of  gourmandizing,  he  also  had  his 
intervals  of  enforced  starvation;  moreover,  the 
constant  quest  of  food  entailed  an  active  mode  of 
life  which  rendered  chronic  over-eating  impossible. 
There  might  be  abundance  of  game,  but  it  had  to 
be  hunted,  the  rivers  might  teem  with  fish,  but  the 
fish  had  to  be  caught;  seeds  and  roots  might  be 
plentiful,  but  they  had  to  be  gathered.  Hence, 
though  in  seasons  of  plenty  primitive  man  may 
have  grown  plump,  obesity  was  practically  un- 


THE  HUMAN  MACHINE 


189 


known.  These  considerations  suggest  that  though 
man  is  none  the  worse,  and  may,  indeed,  be  all  the 
better,  for  occasional  dietetic  indulgence,  strict 
moderation  in  eating  is  the  ideal  to  be  aimed  at. 

“To  put  briefly  the  chief  lessons  to  be  learnt 
from  man’s  dietetic  history:  The  ideal  dietary 

should  be  simple  in  quality  and  moderate  in 
quantity.  It  should  contain  a certain  proportion, 
say  from  a quarter  to  a third,  of  animal  food. 
Animal  food  requires  little  change,  most  raw 
vegetable  foods  and  all  cooked  starchy  foods,  re- 
quire a great  deal.  Hence,  it  is  advisable  to  give 
most  of  the  starchy  foods  in  a form  compelling 
vigorous  mastication,  and  a certain  proportion  of 
vegetable  food  should  be  consumed  uncooked. 
Care  should  be  taken  to  guard  against  an  excess 
of  sugar.” 

And  not  only  what  we  eat,  but  how  and  when  we 
eat  it,  has  a great  influence  upon  all  the  organic 
functions.  In  many  cases,  nonuniform  meals 
cause  impactions  and  fecal  stasis,  and  our  modern 
method  of  entertaining  is  undoubtedly  very  in- 
jurious to  health.  As  a nation  we  are  rapidly 
becoming  “large-dinner-eaters.”  We  consume  only 
a light  breakfast,  hurry  through  an  inadequate 
lunch,  and  then  conclude  the  day  with  an  enormous 
dinner.  We  sit  and  chat,  and  stuff  and  stuff  and 
stuff.  This  large  dinner  naturally  goes  down 
through  the  alimentary  canal  in  enormous  bulk 


190 


COLONIC  THERAPY 


consisting  largely  of  undigested  food.  Next  day 
we  have  no  appetite  for  breakfast  or  for  lunch,  but 
are  ready  late  in  the  evening  for  another  large 
dinner.  A hasty,  insufficient  breakfast— consist- 
ing usually  of  a cup  of  coffee — produces  few 
stomach  waves;  the  hurried  lunch  likewise  gives 
rise  to  no  mechanical  action  in  the  alimentary 
canal.  Therefore,  we  have  fecal  stasis,  because  we 
have  not  followed  Nature’s  method  of  setting  our 
alimentary  canal  at  work.  If  we  should  eat  a light 
evening  meal,  or  none  at  all  for  a time,  we  should 
have  a desire  for  breakfast,  and  when  we  ingest  a 
normal  breakfast,  taking  plenty  of  time  for  it, 
there  is  stimulation  of  the  intestinal  waves  which 
tends  to  move  our  bowels  so  as  to  carry  off  the 
feces  accumulated  in  the  sigmoid  during  the  course 
of  the  night.  Subsequently  there  would  be  a better 
appetite  for  lunch,  and  we  should  be  unable  to  eat 
a heavy  dinner.  In  this  way  we  should  soon  be 
able  to  eat  about  the  same  amount  of  food  three 
times  a day,  the  quantity  consumed  would  be  less, 
and  its  digestion  better,  and  we  should  avoid  great 
mass  movements  in  the  colon. 

The  trend  of  medical  science  today  is  toward  the 
demonstration  of  the  old  adage:  An  ounce  of 
prevention  is  worth  a pound  of  cure.  This  ten- 
dency is  so  marked  that  it  even  seems  possible  that 
we  may  eventually  come  to  the  Chinese  system  of 
medical  service,  lyhere  the  physician  receives  a 


THE  HUMAN  MACHINE 


191 


regular  stipend  as  long  as  the  family  remains  in 
good  health,  but  has  his  pay  promptly  “docked” 
just  as  soon  as  any  member  of  it  falls  ill.  Al- 
though such  drastic  measures  are  not  yet  neces- 
sary, a similar  tendency  is  everywhere  evident  in 
the  attention  being  given  to  preventive  medicine, 
and  the  realization  on  the  part  of  both  physician 
and  layman  that  a rational  mode  of  life,  and  the 
proper  regulation  of  diet  will  do  more  to  insure 
health  than  all  the  drugs  contained  in  the  pharma- 
copeia. The  human  body  is  an  intricate  piece  of 
machinery,  the  aggregation  of  an  infinite  number 
of  complicated  parts.  Every  mechanic  is  aware 
that  in  order  to  functionate  properly  a power- 
producing  machine  must  in  the  first  place  be  well 
made,  of  good  material  and  properly  set  up,  and  in 
the  second  place  must  be  supplied  with  fuel  of 
suitable  nature  and  amount  and  kept  constantly 
cleaned  and  adjusted  so  that  it  may  give  a maxi- 
mum service,  at  a minimum  of  upkeep  cost.  The 
human  machine  is  no  exception  to  this  rule.  Life 
— its  labors,  hardships  and  pleasures — is  its  out- 
put, and  the  reason  for  its  existence.  Though  the 
founders  of  this  republic  declared  that  we  are  all 
“born  free  and  equal,”  the  experience  of  those 
“trouble  men”  whose  vocation  is  to  overhaul  the 
human  machine  and  put  it  in  order,  leads  them  to 
the  conviction  that  the  mechanical  equipment  of 
some  of  us  is  vastly  superior  to  that  of  others. 


192 


COLONIC  THERAPY 


But  it  also  teaches  them  that  even  when  the  engine 
is  of  poor  construction,  careful  adjustment  of 
parts,  selected  fuel,  and,  more  than  all,  a regular, 
thorough  and  systemic  cleaning  out  of  all  the 
refuse  of  combustion  will  go  a long  way  toward 
keeping  the  product  up  to  the  desired  standard. 

To  raise  the  general  standard  of  hygiene;  to 
make  poor  health  good  and  good  health  better;  to 
make  it  possible  for  succeeding  generations  to 
enjoy  only  the  very  best — this  is  the  object  toward 
which  this  small  contribution  has  been  made. 


BIBLIOGRAPHY 


1.  Darwin,  Charles:  The  foundations  of  the  origin  of 

species,  a sketch  written  in  1842.  Cambridge 
(Eng.),  1909. 

2.  Russell,  E.  S.:  Form  and  function.  London,  John 

Murray,  1916. 

3.  Osborn,  H.  F. : The  age  of  mammals  in  Europe, 

Asia  and  North  America.  New  York,  1910. 

4.  Crile,  G.  W. : Man — an  adaptive  mechanism. 

(Edited  by  Annette  Austin,  A.B.),  Macmillan  Co., 

1916. 

5.  Stapley,  William,  and  McKenzie,  Wm.  : A study 

of  monotremes  and  marsupials  to  determine 
changes  in  the  structure  of  the  caecum  and  its 
vermiform  appendix.  Australian  M.  J.,  15 : 401, 
Aug.  20,  1910. 

6.  Ford,  W.  W.,  Blackfan,  K.  D.,  and  Batchelor, 

M.  D. : Some  observations  on  intestinal  bacteria  in 
children.  Am.  J.  Dis.  Child.,  14:354,  November, 

1917. 

7.  Kendall,  A.  I. : Bacteriology ; general,  pathological 

and  intestinal.  2d  ed.,  Lea  & Febiger,  1921. 

8.  Duval  and  Roux:  Arch.  des.  Mai.  de  l’App.  Dig., 

10:795,  1920. 

9.  Stauffer,  W.  H. : Mucous  colitis.  J.  A.  M.  A., 

7 : 1496,  November  27,  1920. 

10.  Fleming,  George  : Chauveau’s  comparative  anatomy 
of  the  domesticated  animals.  2nd  English  ed., 
193 


194 


BIBLIOGRAPHY 


D.  Appleton  & Co.,  New  York,  1891.  Leyh:  quoted 
by  Fleming  (p.  491). 

11.  Elliot  and  Barclay-Smith  : J.  Physiol.,  31:272, 

1904. 

12.  Ferguson,  J.  S. : Normal  histology.  D.  Appleton 

and  Co.,  1909. 

13.  Bundy,  E.  R. : Anatomy  and  physiology.  5th  ed., 

P.  Blakiston’s  Son  & Co.,  1923. 

14.  Bassler,  A.:  Diseases  of  the  Intestines.  F.  A.  Davis 

Co.,  1920. 

15.  Alvarez,  W.  C.:  Mechanics  of  the  digestive  tract. > 

P.  B.  Hoeber,  New  York,  1922. 

16.  Jacobi:  Arch.  f.  exper.  Path.  u.  Pharmakol., 

27:147,  1890. 

17.  Cannon,  W.  B. : The  mechanical  factors  of  diges- 

tion. Longmans,  Green  and  Co.,  1911. 

18.  Case,  James  T. : The  x-ray  investigation  of  the 

colon.  Surg.  Gynec.  & Obst.  (Internat.  Abst. 
Surg.),  19:581,  December,  1914. 

19.  Kellogg,  J.  H. : Colon  hygiene.  Good  Health  Pub. 

Co.,  1916  (p.  92). 

20.  Schellberg,  O.  B.:  Systemic  disturbances  due  to 

colonic  infection.  Am.  Med.,  17 : 636,  Nov.,  1922. 

21.  Cammidge,  P.  J. : The  faeces  of  children  and  adults. 

Wm.  Wood  and  Co.,  1914. 

22.  Stokes,  C.  F. : Am.  J.  Electrol.  and  Radiol.,  41:73, 

March,  1923. 

23.  Taylor,  F.  B.,  and  Alvarez,  W.  C. : The  effect  of 

temperature  on  the  rhythm  of  excised  segments 
from  different  parts  of  the  intestine.  Am.  J. 
Physiol.,  44 : 344,  1917. 

24.  Case,  James  T. : Loc.  cit. 


BIBLIOGRAPHY 


195 


25.  Lynch,  J.  M. : Diseases  of  the  rectum  and  colon. 

Lea  and  Febiger,  1914. 

26.  Gant,  S.  G. : Constipation,  obstipation  and  intestinal 

stasis.  2nd  edition,  W.  B.  Saunders,  1916. 

27.  Hurst,  A.  H. : Constipation  and  allied  intestinal 

disorders.  2nd  ed.,  H.  Frowde,  1919. 

28.  Pfahler,  G.  E. : Adhesions  and  constrictions  of  the 

bowel ; their  demonstration  and  clinical  significance. 
J.  A.  M.  A.,  59 : 1770,  Nov.  16,  1912. 

29.  Schellberg,  O.  B. : The  incorrigible  colon  corrected 

by  medicated  irrigation.  Internat.  J.  Surg.  35 : 
208,  June,  1922. 

30.  Gael  and,  Wm.  H. : The  Schellberg  treatment  for 

chronic  colonic  infections.  N.  Y.  Med.  J.,  114: 
106,  July  20,  1921. 

31.  Schellberg,  0.  B.:  Technic  of  colon  irrigation. 

Internat.  J.  Surg.,  36:18,  January,  1923. 

32.  Hutchison,  Robert:  The  chronic  abdomen.  Brit. 

M.  J.,  1 : 667,  April  21,  1923. 

33.  Campbell,  Harry:  The  evolution  of  man’s  diet. 

Contained  in  A System  of  Diet  and  Dietetics. 
Edited  by  G.  A.  Sutherland,  Oxford  Med.  Pub., 
1908. 


INDEX 


Abdomen,  chronic,  172-181 
Abdominal  belt,  misuse  of,  183 
Absorption  of  solutions  from  in- 
testine, 112 

Adaptive  radiation,  law  of,  20 
Adhesions  due  to  intestinal  per- 
foration, 80 

intestinal  interlining,  78,  133 
Adrenalin  ointment  in  colonic 
spasms,  124 

Alcohol  less  injurious  than  too 
much  sugar,  186 

Alimentary  canal,  autonomy  of, 
55,  74 

efficient  incubator,  39 
evolution  of,  19-32 
focus  of  infection,  31 
variations  in  different  animals, 
47 

Allbutt,  Sir  Clifford,  174 
Alvarez,  W.  C.,  55,  74 
American  Electro-Therapeutic 
Association,  72 
Ampulla  of  rectum,  54 
Angina  pectoris,  vasomotor,  168 
Animals,  Australian,  23-28 
Antiseptics  and  bacterial  implan- 
tations, 139-148 

Apparatus  for  irrigation,  106-107 
cecum  tube,  106 
irrigator,  106-107 
temperature  control,  107 
three-way  valve,  107 
Appendices  epiploicae,  83 
Appendix.  See  Vermiform  ap- 
pendix 

Arthritis,  cause  of,  123 


Asthenia  due  to  corset  wearing, 
184-185 
Australia,  23 

Autonomy  of  the  gastrointes- 
tinal tract,  55,  74 

Bacillus  acidophilus,  123,  129, 
139-148 

merits  of,  142 
aerobic  liquefying,  37 
aerogenes  capsulatus,  44,  96, 

97,  98,  99,  100,  101,  102, 
145 

biftdus,  36 

bulgaricus,  123,  139-148 
merits  of,  142 

coli,  30,  36,  41,  44,  96,  97,  98, 
99,  100,  101,  102 
Gram-negative,  36,  44 
Gram-positive,  36,  44,  96,  97, 

98,  99,  100,  101,  102 
lactis  aerogenes,  44 

Bacteria,  predominance  of  dif- 
ferent types  of,  44 
intestinal,  35-44 
seasonal  variations  in,  39 
Bacterial  implantation,  139-148 
results  obtained  from,  144 
technic  of,  140-141 
Barium  meal,  128 
Batchelor,  M.  D.,  36 
Bauhin’s  valve,  49 
Biliousness  due  to  milk  diet, 
61 

Blackfan,  K.  D.,  36 
Blood  stasis,  154-155 
Bowel.  See  Intestine 


197 


198 


INDEX 


Breath,  fecal  odor  of,  159 
Bundy,  E.  R.,  54 
Bunge,  60 

Cammidge,  P.  J.,  62-63,  79 
Campbell,  Harry,  186 
Cannon,  W.  B.,  58 
Case,  J.  T.,  58,  80 
Case  reports,  asthenia  due  to  cor- 
set wearing,  184-185 
fecal  accumulation  following 
milk  diet,  121-123 
illustrating  various  pathologic 
conditions,  96-102 
mental  depression  due  to 
colonic  stasis,  167 
restoration  of  organs  to  nor- 
mal position,  127-130 
Casts  of  the  bowel,  78-79 
Catharsis  does  not  drain  the  sys- 
tem, 76 

in  conjunction  with  irrigation, 
148 

in  mucous  colitis,  43 
produces  vomiting,  158 
uselessness  in  colonic  stasis,  75 
Cecum,  lining  in  man  and  ani- 
mals, 53 
of  horse,  24 
of  marsupials,  24 
passing  tube  into,  126 
treatment,  cure  for  “chronic 
abdominalism,”  181 
unloading  a distended,  111 
Chemicals  seldom  reach  the  colon 
in  curative  form,  105 
Children,  feces  of,  36-37,  63 
school  examination  of,  32 
Chlorinated  soda,  solution  of, 
108,  111,  113 

Chronic  abdomen,  172-181 
Circulation,  constriction  of,  154 
stasis,  154 


Colitis,  mucous,  43 
Colloidal  silver  solution,  108,  109, 
112 

Colon,  action  of  gases  in,  59 
bleeding  from,  109 
carcinoma  of,  83 
Case’s  x-ray  work  on,  81 
clean-up  and  catharsis,  139 
constrictions  of,  83 
contracted  by  vermiform  mus- 
cles, 132 

course  of,  in  man,  49-50 
diverticula,  81 
divisions  of  human,  27 
floating,  116 
function  of  normal,  157 
function  of  sacculations  of,  59 
grounding  point  of  vermiform 
muscles,  155 
hemorrhage  from,  109 
hepatic  flexure  of,  57 
high  “hot,”  92 

knowledge  of  its  anatomy  nec- 
essary, 87 

length  of,  in  man,  49 

longitudinal  fibers  of,  50 

may  be  “reformed,”  77 

mucus  strips  in,  158 

nerve  stimulation  of,  164 

nerves  of,  57 

not  like  an  abscess,  131 

redundancy  of,  113 

passing  tubes  into,  117 

ptosis  of,  163 

refilling  of,  161 

sigmoid,  54 

spasms  of,  123,  124 

spastic,  treatment  of,  124-125 

splenic  flexure  of,  132 

stretched,  116 

subdivisions  of,  49 

taenia  of,  50 

traction  muscles  of,  57 


INDEX 


199 


Colon,  transient  sphincter  of,  126 
Colonic  irrigation,  amount  of  so- 
lution carefully  gauged, 
115 

antiseptic,  108 
beginning,  114 
not  a shock,  94 
number  of  treatments,  117 
putrefactive  elements  removed 
by,  89 

restores  intestinal  activity,  74 
simpler  and  safer  than  sur- 
gery, 88 

solutions  for,  108,  109,  114 
special  applications  of,  118-135 
technic  of,  105-118 
without  special  apparatus,  OS- 
94 

Colonic  stasis  responsible  for  en- 
docrine dysfunction,  72 
Constipation,  an  inadequate  term, 
153 

Corium  of  small  intestine,  52 
Corset-wearing,  185 
Crabbe,  178 
Crile,  G.  W.,  21-23 
Culture  medium  for  B.  acidoph- 
ilus, 147-148 

Darwin,  Charles,  19,  20 
Defects  of  the  visceral  organs,  96 
adjustment  of,  96 
Devil,  Tasmanian,  24-27 
Diet,  faults  in  modern,  189-190 
meat  less  harmful  than  sugar, 
187 

milk,  60-62 

primitive  human,  21,  188-189 
refinements  of,  29 
secondary  factor  in  growth  of 
putrefactive  organisms,  40 
Divergence,  law  of,  20 
Duodenum,  48 


Enema,  soap-suds,  94 
useless  as  ordinarily  employed, 
89-90 

Epilepsy,  31,  100 
Epsom  salts,  use  of,  76 
Experience  in  passing  cecum 
tube,  126 

Fecal  impaction,  removal  of, 
from  colon,  158 
residue,  160 

stasis,  consequence  of,  153-168 
due  to  sleeping  on  right  side, 
163 

variation  of  effect  of  in  dif- 
ferent individuals,  154 
Feces,  appearance  of,  160 
constituents  of  human,  62-63 
of  children,  36-37 
yeasts  in,  36-37 
Flora,  intestinal,  35-44 
seasonal  variations  in,  39 
Foci  of  infection,  attention  re- 
cently paid  to,  70 
in  cecum,  123 

direct  cause  of  disease,  153 
not  always  in  the  head,  71 
Follicles,  agminated,  52 
solitary,  52 
Ford,  W.  W.,  36 

Galland,  W.  H.,  89 
Gant,  S.  G.,  83 

Gas,  fecal,  expelled  by  lungs,  159 
in  colon,  difficulty  of  removing, 
116 

Glands,  agminated,  52 

Hepatic  flexure,  57 
Hernia  of  the  mucosa,  82 
High  hot  colon,  92 
High-temperature  solution  stimu- 
lates colon  waves,  114 


200 


INDEX 


Human  machine,  171-192 
adjustment  of,  191 
Hutchison,  Robert,  171,  181 
Hypotonia,  167 

Ileocecal  valve,  49 
backfire  of  gases  through,  66 
incompetency  of,  126 
structure  of,  54 
Infants,  artificially  fed,  36 
fecal  flora  of,  35-38 
Infection,  focal.  See  Foci  of  in- 
fection 

Intestine,  anatomy  and  physiol- 
ogy of,  47-65 
casts  of,  78-79 
flora  of,  35-44 
in  cat  family,  49 
in  marsupials,  24 
interlining  adhesions,  78,  133 
large;  see  Cecum,  Colon 
length  in  adult  man,  48 
in  cat,  48 
in  horse,  48 

marginal  blood-vessel  parallel 
to,  154 

secretions,  analysis  of,  69 
ingredients  of,  65 
small,  villi  of,  51 
stasis,  cause  of  putrefactive 
processes,  42 
subdivisions  of  large,  49 
toxins,  41,  42,  43 
x-ray  examination,  80-81,  84, 
96-102,  130,  136 
Intra-abdominal  pressure,  90 
Irrigation.  See  Colonic  irriga 
tion 

Jacobi,  58 
Jej  uno-ileum,  48 
Jejunum,  48 


Kangaroo,  24 
Kellogg,  J.  H.,  60-62 
Kendall,  A.  I.,  38 
Koala,  24-27 

Lane,  Sir  Arbuthnot,  77 
Lettuce,  digestibility  of,  60 
Locomotion  of  serpents,  156-157 
Longitudinal  fibers  of  colon,  50 
Lynch,  J.  M.,  82 

MacKenzie,  William,  23,  27 
Mammals,  primitive  types  of,  20 
Marginal  blood-vessel  parallel  to 
bowel,  154 

Marsupials,  24,  26-28 
Meconium,  35 

Mental  disturbance,  relation  to 
digestive  disease,  163-168 
Metabolism,  cellular,  30 
changes  in,  during  disease,  70 
errors  in,  71 

Microorganisms  in  internal  chem- 
istry, 30 
intestinal,  35-44 
types  of,  44 

Milk,  bacillus  acidophilus,  123, 
145 

diet,  condition  of  colon  after, 
121-122 
sugar  of,  146 
Monotremes,  24 
Mucous  colitis,  43 
Mucus  strips  in  colon,  158 
Mushrooms,  digestibility  of,  60 

Natural  selection,  theory  of,  19 
Nerves  of  alimentary  canal,  164 
Neurotic,  definition  of,  181 
Number  of  patients  treated,  142 

Olive  oil,  95 

Omnivorous  adaptation,  21 


INDEX 


Osborn,  H.  F.,  20,  21 
Owen,  Richard,  156 

Pain,  difficulty  of  localizing,  lev- 
ies 

transferred,  165-166 
wrongly  attributed  to  inflamed 
appendix,  165 

Patients,  condition  of,  after  bac- 
terial implantation,  145- 

146 

Peristalsis,  definition  of,  55 
mechanism  of,  56 
reverse,  58 
waves,  course  of,  55 
Peyer’s  patches,  52-53 
Pfahler,  G.  F.,  83 
Pneumococcus,  30 
Position  of  patient  in  gastropto- 
sis  and  coloptosis,  163 
to  relieve  splenic  flexure,  132 
when  colon  is  not  transposed, 
114 

with  floating  and  stretched 
colon,  116 

Postoperative  conditions,  treat- 
ment of,  182-183 
recurrences,  161 
Preventive  medicine,  190-191 

Rami  communicantes,  57 
Rectum,  description  of,  54-55 
Relative  merits  of  Bacillus  acido- 
philus and  Bacillus  bul- 
garicus,  142 

Results  of  general  “clean-up,” 

147 

Russell,  E.  S.,  20 

Sacchabides,  injurious  effects  of, 
187-190 

Serpents,  156-157 
Sigmoid,  54 


201 

Solutions  for  irrigation,  antisep- 
tic, 109 
formulas,  108 

high  temperature  stimulates 
colon  waves,  114 

Spasms  of  colon,  adrenalin  oint- 
ment in,  123 

Spinach,  iron  content  of,  60 
Stapley,  William,  23 
Stauffer,  W.  H.,  43 
Stokes,  C.  F.,  72,  131 
Stomach,  digestive  functions  of, 
63 

of  carnivora,  47 
ptosis  of,  163 

variation  in  different  animals, 
47 

Strassburger,  43 
Sugar  of  milk,  146 

Tvenia  coli,  50 
Tasmanian  devil,  24-27 
Tomatoes,  digestibility  of,  60 
Toxins,  effect  of,  upon  the  nerv- 
ous system,  43 

generated  by  moisture  in  bowel 
content,  42 
intestinal,  41,  42,  43 
produced  by  anatomic  defect 
in  intestinal  wall,  41 
Treatments,  number  of,  in  au- 
thor’s clinic,  117 

Vagotonia,  167 
Valvulae  conniventes,  51 
Vermiform  appendix,  location  of, 
in  man,  49 
of  wombat,  24 

Vermiform  muscles,  grounding 
point  in  pelvic  colon,  155 
of  serpents,  156-157 
Villi  of  small  intestine,  51 


INDEX 


202 

Vomiting  induced  by  hot  enema, 
158 

result  of  stimulating  medulla, 
162 

Wombat,  24-27 

X-rays,  Case’s  work  on,  80-81 


X-rays,  diagnoses,  96-102 
of  colon,  likened  to  silhouette, 
84 

preparation  of  patient  for  ex- 
amination, 136 
rectal  tube  in  colon,  130 

Yeasts  in  children’s  feces,  36-37 


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